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Full text of "U.S. NAVY MEDICINE Vol. 70, No. 11 November 1979"

VADM Wiilaid P. Arentzen, MC, USN 

Surgeon General of the Navy 

RADM H.A. Sparks, MC, USN 

Deputy Surgeon General 

Director of Public Affairs 

LTJG Richard A. Schmidt, USNR 

Editor 

Jan Kenneth Herman 

Assistant Editor 

Virginia M. Novinski 

Editorial Assistant 
Nancy R. Keesee 



Contributing Editors 

Contributing Editor-in-Chief: CDR E.L. Tay- 
lor (MC); Dental Corps: CAPT R.W. Koch 
(DC); Education: LT R.E. Bubb (MSC); Oc- 
cupational Medicine: CAPT J.J. Bellanca 
(MC); Preventive Medicine: CAPT D.F. 
Hoeffler (MC) 



POLICY: US- Navy Medicine U an official publication 
of the Navy Medical Department, published by the Bureau 
of Medicine and Surgery. It disseminates: to Navy Medical 
Department personnel official and professional information 
relative to medicine, dentistry, and the allied health sci- 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other governmental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and Surgery. Although US. Navy Medi- 
cine may Cite or ei tract from directives, official authority for 
action should he obtained from the cited reference, 

DISTRIBUTION: US, Navy Medicine is distributed to 
active-duty Medical Department personnel via the Standard 
Navy Distribution List. The following distribution is author- 
ized: one copy For each Medical. Dental. Medical Service 
and Nurse Corps officer: one copy for every 10 enlisted 
Medical Department members. Requests to increase or de- 
crease the number of allotted copies should be forwarded to 
US- Navy Medicine via the local command. 

CORRESPONDENCE: All correspondence should be 
addressed to: Editor. US. Navy Medicine, Department of 
the Navy, Bureau of Medicine and Surgery {MED 001 D). 
Washington, D.C. 20372. Telephone: (Area Code 202) 254^ 
4253. 254-4316, 254-4214; Autovon 294-4253, 294-4316. 294- 
4214. Contributions from the field are welcome and will be 
published as space permits, subject to editing and possible 
abridgment. 

The issuance of this publication is approved in accordance 
with Department of the Navy Publications and Printing 
Regulations (NAVEXOS P-35). 



U. S. NAVY 
MEDICINE 



Vol. 70, No. 11 
November 1979 



1 From the Surgeon General 



2 Department Rounds 

The Diver's Friend . 



'Corpsman!" 



NAVMED P-S088 



6 Special Report 

The Surgeon General's 11th Annual Specialties Advisory Confer- 
ence and Committees' Meeting 
6 Surgeon General's Keynote Address 

VADM W.P. Arentzen, MC, USN 
9 Current Status of Medical Department Manpower 

RADM M. Museles, MC, USN 
12 Medical Corps Status Report 

CAPT J.E. Can, MC, USN 
15 Education Programs and Scholarships for the Naval Medical 

Department 

CDR C.B. Mohler, MSC, USN (Ret.) 

17 Navy Urology: A Status Report 
CDR S.M. Steele, Jr., MC, USN 

18 Recommendation Made as Chairman of the SAC XI Opera- 
tional Medicine Committee 

RADM C.H. Lowery, MC, USN 

18 Findings of the Otolaryngology Committee 
CAPT C. G. Strom, MC, USN 

19 Protection of Human Subjects 
CDR H.M. Koenig, MC, USN 

20 Question and Answer Session 

23 Roster— 1 September 1979 

Staff Medical and Dental Officers at Major Activities 

27 Notes and Announcements 
29 BUMED SITREP 



COVER: A wounded Marine is rushed aboard a Medivac helicopter. 
Speedy evacuation from the battlefields of Southeast Asia saved 
countless lives by shortening the interval between injury and treat- 
ment. In periodic field exercises, Navy hospital corpsmen continue to 
hone their skills for the time they may again be needed. Story on p. 4. 



FROM THE SURGEON GENERAL 



The Role of Occupational Medicine: 
Everyone's Concern 



How often we overlook the obvious! 
How frequently we accept the ubiq- 
uitous as a matter of unchangeable 
"natural" fact. Once in a while, 
someone rises up to say, "No, this 
cannot continue! We can no longer 
tolerate these conditions. A more 
acceptable manner must be found." 

In America today, the work force 
includes 97,401,000 people. Statis- 
tics for 1977, the most recent data 
published by the Bureau of Labor 
Statistics, show 4,760 people died 
as a result of work-induced or work- 
related reasons. An additional 
5,460,300 were injured severely 
enough to warrant reporting. 

For generations, medical people 
have reported their observations on 
work-related illnesses, and la- 
mented the continuation of these 
same poor practices — practices that 
have exploited the worker and have 
either slowly or rapidly impaired the 
health of people. As chemistry and 
other disciplines have become more 
sophisticated, we have introduced 
into the worker's world, materials 
and processes which have created 
additional sources of health impair- 
ment. 

Today's Navy is no exception. We 
utilize many of these complex 
materials and processes. Often, 
physical changes which result are 
largely irreversible by the time of 




first observation. This is true in the 
changes seen from exposures to 
asbestos, mercury, manganese, and 
lead to cite just a few. Along with 
our counterparts in the private 
sector, we must continue to strive 
for the prevention of all occupa- 
tionally-related health insults to 
people, ashore and afloat. 

The Medical Department must 
provide activity commanders with 
advice and recommendations on 
how to improve and maintain satis- 
factory working conditions. Medical 
and administrative processes for 
selection and surveillance of per- 



sonnel must be refined and imple- 
mented at all Navy activities and in 
all operating units. 

Our occupational health profes- 
sionals are dedicated to these ends. 
We have an occupational health 
staff in the Navy which is outstand- 
ing in quality and motivation, if not 
yet great enough in numbers. All of 
the Navy is aware of the need to 
alter these potentially injurious con- 
ditions and to assure, by frequent 
observation, that present controls 
are adequate and that new hazards 
are not introduced. 

A progressively larger portion of 
our resources is being committed to 
this growing area of Medical De- 
partment service, and this is inevi- 
table as we recognize more and 
more the support we must provide 
the line organizations, both the ob- 
viously industrial and the operating 
units. 

We must provide all the guidance 
and support possible so that the 
Navy will function in as safe and 
healthful a work environment as is 
currently possible. 



A- 



/ 




W.P. ARENTZEN 

Vice Admiral, Medical Corps 

United States Navy 



Volume 70, November 1979 



1 




LT Linda Hubbell, a Navy Reservist on active duty with HCU-1, climbs into Jim as Petty Officer Cross stands by to assist. 
2 U.S. Navy Medicine 



DEPARTMENT ROUNDS 



The Diver's Friend 



At Pearl Harbor, the Navy recently 
tested what diving experts say could 
be the greatest breakthrough in 
deep-sea diving to date. 

The National Naval Medical Cen- 
ter, Bethesda, Md., in cooperation 
with the British company DHB Con- 
struction, lent Jim to the Pearl Har- 
bor based Harbor Clearance Unit- 
One (HCU-1). 

Jim is a one-atmosphere armored 
diving system which comes in the 
form of a huge, hollow magnesium 
alloy body. The system weighs be- 
tween 1,100 and 1,200 pounds on 
the surface with an operator inside. 
Below the surface, depending on 
the bottom conditions, Jim weighs 
around 60 pounds. 

A member of the team which 
traveled to Hawaii from the main- 
land with Jim, Sonar Technician 
First Class Carl Cross, says the 
project represents "physiological 
research." 

"This testing is to find out what 
the divers do on the bottom, and 
how they operate by testing dif- 
ferent work loads under different 
water temperatures," he says. 

With its hinged dome head, the 
system looks like something from 
another world. Four eye-like win- 
dows in the dome, two in front 
angling up and down, and one 
angling off each side, enable the 
diver to look in almost all directions. 

Jim also has moveable limbs. The 
joints are O-ringed and circular in 
shape, preventing the metal mon- 
ster from freezing up even at its 
maximum diving depth of 1,500 
feet. 

The arms have mechanical ma- 
nipulators, which are clamp-like 



hands flexible enough to pick up a 
dime. Cross says there are different 
types of manipulators, "adapted to 
a particular job or whatever task 
that has to be done." 

The legs, also flexible, permit 
Jim to walk at a 45-degree angle, 
negotiate steps, and bend at the 
waist at an angle parallel to the 
bottom. 




Jim is a one-atmosphere armored diving 
system on loan to the Navy, 



A set of spacers just above the 
boots can be changed to accommo- 
date different operator heights. The 
six-foot, six-inch apparatus can be 
operated by a diver as tall as six 
feet, two inches and weighing 215 
pounds or as short as five-foot, six 
inches. 

Depending upon the weight of the 
diver, Jim can ascend at rates of 100 
feet per minute from the ocean 
floor. 

The one- atmosphere system is 
temperature controlled, protecting 



the diver from freezing by warming 
up and stabilizing his environment 
at 66° to 70° F. Once, Jim dove 905 
feet into the Canadian Arctic Ocean 
through 16 feet of ice and 27- degree 
water. During this series of dives 
Jim broke the record for the longest 
working dive, five hours and 59 
minutes, without any discomfort to 
his operator. 

Jim's main purpose and advan- 
tage is the elimination of decom- 
pression — preventing air embolism, 
commonly known as the bends. 

Other added dvantages include 
extended diving time, permitting 
operators to stay down for as long as 
27 hours breathing their own re- 
cycled air, reduced biochemical 
problems, and increased capability 
for repetitive dives. 

The concept of a system such as 
Jim goes back several centuries. 
Successful systems were developed 
and tested between the first and 
second world wars, but interest 
faded during the middle of World 
War II. 

In 1969 DHB Construction was 
formed to reexamine previously en- 
countered problems in deep-sea 
diving. This investigation resulted 
in a renewal of interest and the 
engineering of Jim. 

The officer in charge of the proj- 
ect here, LT Bill Nelson, NNMC, 
says Jim got its name from a man 
who helped design the system, Jim 
Harris. Harris was also the system's 
primary operator. 

If the tests made with Jim prove 
successful, the system could find it- 
self diving for the Navy. Meantime, 
the huge, space-like creature seen 
diving to the ocean floor off Hawaii 
is no cause for alarm. 

It's only Jim, the diver's friend. 

—Story by J03 Rick Johnson, USN. Photos 
by PH2 Matthew Sapanara, Jr., USN 



Volume 70, November 1979 



44 



Corpsman!" 



Making its way through thick brush, 
a patrol of approximately 30 Ma- 
rines, on a search and destroy mis- 
sion, is suddenly ambushed. Amidst 
the confusion of the ensuing fire 
fight, a wounded Marine cries, 
"Corpsman — Corpsman." Two 
Navy hospital corpsmen assigned to 
the patrol rush to his aid. 

With the sounds of small arms 
fire ringing in their ears, the two 
corpsmen make their way from one 
fallen Marine to another administer- 
ing emergency treatment. The rifle 
fire subsides to a few scattered 
shots but not before taking a toll. 
Four Marines are seriously injured 
and two more sustain minor 
wounds. 

The squad's leading corpsman, 
HM1 Howard Koontz, moves me- 
thodically from one victim to anoth- 
er checking vital signs and dressing 
wounds. He prepares each casualty 
for transport to the Medical Battal- 
ion Field Hospital. 

The radioman calls for a medical 
evacuation helicopter to meet the 
bartered unit at a nearby landing 
zone (LZ). "This is 2nd MARDIV 
calling Medical Detachment 247. 
Meet us at LZ 'Victor,' I repeat LZ 
'Victor.' We have four on stretchers 
and two walking." The radio trans- 
mission is acknowledged but 
breaks up before any further infor- 
mation can be given. The Medivac 
crew, however, has received the 
most important information — where 
to meet the unit and the number of 
casualties. 

Meanwhile, the fighting ends and 
the enemy withdraws. Combat- 
weary Marines, under Koontz' di- 
rection assist in loading their 
wounded comrades on stretchers 
and moving them to the low under- 
brush at the edge of the landing 
zone, a small clearing in the jungle- 



like terrain near where the ambush 
took place. 

A helicopter breaks the calm of 
the warm fall day as it appears over 
the trees to the east and sets down 
in the clearing. A crew chief and 
medical technician open the doors 
as the first stretcher is rushed 
alongside and a wounded Marine is 
hoisted into the helicopter's belly. 
The procedure is repeated three 
more times. The walking wounded 
are then strapped into jump seats, 
the doors are closed, and the copter 
lifts off for the field hospital. 

Once there, the wounded are re- 
moved and taken inside the treat- 
ment tent under the direction of 
HMCM John Onorato and HMCS 
Harry Cave. Attached medical tags 
tell the doctors and nurses the 
nature of the injuries and what has 
already been done. The tags also 
help identify the more seriously 
wounded and the order of treat- 
ment. 

Although this scene was a drill, 
the real thing occurred often enough 
in Korea and Vietnam, For Naval 
Reserve 2nd Marine Division Medi- 
cal Detachment A 206, lead by CDR 
David Kingsbury, MC, USN, and 
assigned to the Naval Reserve 



Center Baltimore, this was part of a 
simulated training exercise at Fort 
Meade, Md. 

"This exercise is the culmination 
of five months planning by our 
unit," said HMCM Onorato. 
"Many of our corpsmen have no 
actual combat experience," added 
his colleague HMCS Cave. 
"They're good people though. This 
exercise helps our unit learn how to 
work with Medivac helicopters and 
the pressure of being under fire. If 
the time ever comes that we're 
called on we'll be ready." Cave 
earned his field Medical Technician 
NEC 8404 under fire in Vietnam. 

The 21 corpsmen assigned to the 
unit are working toward earning the 
Field Medical Technician NEC 
8404. Three corpsmen have earned 
this designation since joining the 
unit. 

All members of 2nd MARDIV 206 
work in some aspect of medicine as 
civilians. Their occupations range 
from hospital administrators and 
medical technicians to doctors and 
nurses. 



—Story by JOl Rich Beth, USN. Photos by 
JOl Rich Beth, USN and JOSN Brian 
Curtice, USN 




Wounded are placed on stretcher racks in Medivac helicopter. 



U.S. Navy Medicine 



Recent Publications by Navy Authors 



Ambulatory Surgery for Pilonidal Disease by CDR 
Henry M. Meinecke, MC, USN. American Surgeon 
45(6):360-363, June 1979. 

The Grand Biopsy for the "Cold" Thyroid Nodule 
by CAPT Fred J. Stucker, MC, USN, LCDR Arthur 
B. Lacher, MC, USNR, and LCDR Ronald H. 
Hirokawa, MC, USN. Laryngoscope Sept 1979. 

Summer Health Fair — Filling the Gap by LTJG 
Daniel A. Wilbur, MSC, USNR. Forum On Medicine 
May 1979. 

The Epidemiology of Human Pediculosis in 
Ethiopia by CDR L.L. Sholdt, MSC, USN, HMC 
M.L. Holloway, USN, and Dr. W.D. Fronk. Special 
Publication of the Navy Disease Vector Ecology and 
Control Center, Jacksonville, Fla., 1979. 



The following are papers published or issued by 
Naval Medical Research Institute military and civil- 
ian investigators at NNMC Bethesda, Md., since the 
beginning of 1979. 

The Solubility of Hydrogen Cyanide in Water by 
Rodkey FL and Robertson RF. Journal of Combus- 
tion Toxicology 6:44-47, 1979. 

Defective Transient Endogenous Spleen Colony 
Formation in SI/SID Mice by Wiktor-Jedrzejczak, 
McKee A, Ahmed A, Sell KW, and Sharkis SJ. 
Journal of Cellular Physiology 99:31-36, 1979. 

Pressure, Anesthetics, and Membrane Structure: 
A Spin-Probe Study by Finch ED and Kiesow LA. 
Undersea Biomedical Research 6(l):41-45, 1979, 

Microwave Radiation and Chlordiazepoxide: 
Synergistic Effects on Fixed-Interval Behavior by 
Thomas JR, Burch LS, and Yeandle SS. Science 203: 
1357-1358, 1979. 

Summary of the First International Workshop on 
Human Primed LD Typing by Hartzman RJ. Tissue 
Antigens 13:203-211, 1979. 



An Explanation of Impaired Solute Mixing in 
Extracellular Fluid after Hemorrhagic Hypotension 
by Small A and Homer LD. American Journal of 
Physiology 236(3):H440-H446, 1979. 

Scanning Electron Microscopy of Spironucleus 
{Hexamita) Muris Infection in Mice in Scanning 
Electron Microscopy/ 1979/111 by Eisenbrandt EL 
and Russell RJ. AMF O'Hare, 111., Sem, Inc., pp 23- 

27, 1979. 

Endotoxin Lethality and Tolerance in Mice: 
Analysis with the B-Lymphocyte — Defective CBA/N 
Strain by Zaldivar NM and Scher I. Infection and 
Immunity 24<1>:127-131, 1979. 

Different Marrow Cell Number Requirements for 
the Haemopoietic Colony Formation and the Cure of 
the W/WV Anemia by Wiktor-Jedrzejczak, Sharkis 
SJ, Szczylik C, Ahmed A, and Gornas P. Experientia 
35(4):546-547, 1979. 

Endoscopy as an Aid to Endodontic Diagnosis by 
Detsch SG, Cunnningham WT, and Langloss JM. 
Journal of Endodontics 5(2):61-62, 1979. 

Lymphocyte Binding and T Cell Mitrogenic 
Properties of Group A Streptococcal Lipoteichoic 
Acid by Beachey EH, Ahmed A, Dale JB, Simpson 
WA, Grebe S, and Ofek I. Journal of Immunology 
122(1):189-195, 1979. 

Changes in Surface Immunoglobulin Isotypes on 
Purified Antigen-Binding Cells after Antigenic 
Stimulation by Kenny JJ, Ashman RF, Kessler SW, 
Scher I, and Ahmed A. Journal of Immunology 122 
(5):2037-2044, 1979. 

Computer Model for Simulation of Emergency 
Medical Systems by Fletcher JF and Delfosse C. 
Military Medicine 144(4) -.231-235, 1979. 

Specificity of Primed LD Typing: The Major Reac- 
tions by Hartzman RJ, Johnson AH, Sell KW, Amos 
DB, Ward F, Pappas F, and Romano PJ. Transplan- 
tation Proceedings ll(l);690-695, 1979. 



Volume 70, November 1979 



SPECIAL REPORT 



The Surgeon General's 11th Annual 
Specialties Advisory Conference 
and Committees 9 Meeting 



The conference was held 10-14 September 1979 in 
B.ethesda, Md. Following is a report of the first plenary 
session of this annual conference. 

This report represents an edited {sometimes para- 
phased or abbreviated) version of the remarks and 
presentations of specified individuals. Their comments 
do not necessarily reflect official views of the Navy 
Department or the naval service at large. — Ed. 



Surgeon General's Keynote 
Address 

VADM W.P. Arentzen, MC, USN 
Surgeon General of the Navy 

Three years ago I addressed this convocation for the 
first time. The thrust of my message then was my 
absolute desire to support fully our operational forces 
and to eliminate the "two Medical Departments syn- 
drome." I stated clearly my firm conviction that hospi- 
tal-based practice including the care of dependents and 
retired was just as contributory to fleet readiness as 
anything we do from the platform of a ship's deck or an 
airplane. 

We have made giant strides toward achieving those 
ends. Shortly after becoming Surgeon General, I insti- 
tuted the curriculum in operational medicine which is 
an integral part of the GME-1 experience. Yesterday, 
our first operational medicine course commenced in 
Pensacola. I have insisted that we adhere as closely as 
possible to the policy of providing an operational ex- 
perience for our young physicians when they complete 
their internships and before they re-enter the graduate 
education structure. As with most new things, there 
was initial resistance but as time has passed, general 



acceptance has occurred. Interviews with many of these 
young men and women upon their return to various 
training programs has almost without exception pro- 
duced the same evaluation: "I wasn't particularly look- 
ing forward to it but I enjoyed it." The relief from the 
tension of the internship year and the opportunity for 
reflection before plunging into the rigors of graduate 
training were very positive side benefits. We have 
adhered to our pledge that, everything else being 
equal, applicants for further training from the opera- 
tional assignments receive top priority consideration. 
We have done that and our credibility on that point is 
high. 

The readiness of our surgical teams has been im- 
proved and we are paying increased attention to train- 
ing for combat surgery, especially burns and trauma. 
We have recently participated in the 3rd Marine Am- 
phibious Force exercises in West PAC to demonstrate 
our augmentation capabilities and the preliminary re- 
ports indicate that everything went well. 

The establishment of the abbreviated clinical resi- 
dencies — the "mini-residency program" — has been 
another bridge uniting the operational and hospital 
medical communities. This is not designed to be a 
remedial program. Rather it is for the purpose of up- 
dating skills to facilitate career progression through the 
entire Medical Department field of responsibility. It has 
been successful but it needs to be expanded. 

We have, I think, convinced the top echelon of the 
line Navy of our intent to support the active duty forces 
of the Navy and Marine Corps. Our credibility in that 
arena is also high. It is important that we be believed. 
The credibility of government with the public is a 
continuing issue — an issue of such importance that 
journalists have built reputations and have gained ac- 
claim by the exposure of even marginal differences in 
public and private official rhetoric. It is no less true 



U.S. Navy Medicine 



within government or within the Navy. Our constituents 
have the right to expect us to keep our word. They have 
the obligation to treat us in a similar fashion. 

As pleased as I am to see the progress we have made 
along this front, there is still much more to be done. But 
we have made a beginning — a large beginning — and I 
thank you for that. 

But, we've been talking about a lot of other things for 
the past three years. How have we done in relation to 
those other problems? The report is a mixed one. 

Our shortfall in physicians is considerably dimin- 
ished. By the end of this month we hope to have 
brought on board 200 new physician volunteers this 
year — the best year we've ever had. Equally heartening 
is the fact that the quality of these volunteers is so 
good. As the output of physicians in the United States 
continues to enlarge, I expect to see this trend con- 
tinue. We expect to be about 54 physicians short as the 
new year begins. I fully expect that deficit to completely 
disappear within the next year. Retention is up, volun- 
teers are up, and the output from the scholarship pro- 
gram continues to increase. Our scholarship program 
again is filled; almost 1,000 applications were received 
for 433 billets. 

We will defer more students this year for full training 
in the civilian sector. By the time SAC XII convenes we 
should be fully implementing our in-house Berry Plan. 
If there is one project I would like to be remembered 
for, it is this one. The input from civilian training pro- 
grams is a key element in maintaining our excellence. 
Inbreeding is fatal to medical institutions. There is 
more than one way to do things. We should be con- 
stantly challenged by new ideas, stimulated by fresh 
viewpoints. We need to cherish our iconoclasts, not 
destroy them. 

Our recruitment of dentists is going very well and we 
are at our authorized strength despite the loss of the 
dental scholarship program. The loss of that program 
continues to disturb me. We will be watching what 
happens to recruiting in this community very closely. 

Nurse Corps recruiting has never been a real prob- 
lem but authorized numbers have been. The problem 
will increase as the role of nursing expands. Anes- 
thetists and nurse practitioners of all sorts are serving 
as physician extenders, but these individuals reduce 
the available numbers to provide hands on nursing 
care. It is my hope that a rational staffing plan based at 
least in part on a patient classification system can help 
us determine the real numbers we need system-wide. 

The Medical Service Corps continues to be healthy 
with a few exceptions. We have our first uniformed 
audiologists on board now and will shortly have our first 
wave of uniformed social workers. These newest mem- 



bers of the MSC family will be of tremendous benefit to 
us as we intensify our efforts in hearing conservation 
and family advocacy. 

We have recently reopened our physician's assistant 
training program. The first 45 selectees are in training 
at Portsmouth and San Diego. We are attempting to 
obtain an additional 235 PA billets. We know that PA's 
are valuable members of our health care team; they 
help us meet the overwhelming demand for ambulatory 
care. We have recently assigned 12 PA's to carriers. 
This is a new role for the PA, one in which the PA can 
help us improve our service to the line Navy. I ask each 
of you here to take a personal interest in PA training. It 
is not just the other man's job — it is everyone's job to 
insure that we provide the best training possible to all 
our young professionals. 

The poorest news is in the Hospital Corps. I didn't 
have to tell you, did I? This was a problem when I be- 
came Surgeon General. It remains one and perhaps has 
become a more serious one. We have managed to cope, 
one way or another, with all our other problems, 
money, physicians, etc. But this one will defeat us if not 
solved. Because of decreased recruiting Navy-wide, we 
are not filling the seats in "A" School. And that is our 
pipeline. The impact of that circumstance is beginning 
to be felt in the "C" Schools with more empty seats and 
higher attrition rates. We are dangerously close to the 
outer limits of coping. We are so short of radiology 
technicians that our capability to train new ones is 
being compromised. 

Pharmacy technicians are at 85 percent of allowance. 
The reason we are not at the full strength at this time is 
because the field is converting more billets to pharmacy 
techs which is, of course, a catch-22. We have less quad 
O's. Also, there is now a market for pharmacy techs on 
the outside. If we retain what we have this year we will 
be at 100 percent of manning with the present people in 
the pipeline. 

General duty hospital corpsmen are no more avail- 
able than the others because so many have been con- 
verted' into tech billets. 

OR techs are at full allowance. We actually have an 
excess. Clinical techs are in excess. Basic lab techs are 
at strength. Advanced lab techs are short because this 
past year 170 new billets were created. 

The CO's are now calling and saying, "I can do 
without more doctors; send me corpsmen." Without 
sufficient ancillary personnel, the efficiency and pro- 
ductivity of our physicians is much less than optimal. 
These young men and women work their hearts out for 
us but we can't stretch them beyond endurance. No 
staffing study done by SHORESTAMPS (Shore Re- 
quirements Standards and Manpower Planning Sys- 



Volume70, November 1979 



terns) or any other group has found that we were over- 
staffed with corpsmen in any NEC. I have lost my pa- 
tience. Do we have to discover America every October? 
We have had some success with equipment pur- 
chases since my first address to this conference. More 
money for major equipment has been available. It has 
not been sufficient to wipe out our backlog but it has 
kept us afloat and we have made a large dent in the 
backlog. I expect we'll continue at about the same level 
of funding next year. I realize that telling your staff 
they're going to get a piece of equipment in 1981 
instead of 1983 doesn't mean much when they need it in 
1979. I know that doesn't draw a round of applause, but 
the real world is closing in, closing in on us and the 
civilian institutions as well. 

I should have said the future is closing in on us. 
Whether we like it or not, medical care in the United 
States is about as large as it's going to get. Because of 
the high cost, national health insurance is still way 
down the road but steady pressure toward a complete 
reorientation of health care priorities will be with us. 

America is now spending more than $200 billion a 
year on health care. Only a small proportion of that is 
devoted explicitly to the prevention of disease and pre- 
mature deaths. The notable decline in deaths from 
heart attacks in the last 10 years is attributable not only 
to improvements in medical technology and treatment 
but also to the fact that more people are taking better 
care of themselves. Evidence is mounting that in 
modern societies continued growth in medical care — 
more physicians, more nurses, more hospitals and the 
like — probably leads to only a marginal betterment in 
the overall health of the general population. People who 
live in areas where there are a lot of doctors seem to be 
neither more nor less healthy than people who live in 
areas where doctors are scarce, Ready access to medi- 
cal care while desirable does not appear to be as signifi- 
cant as once assumed in determining the state of 
health. It may be that health may depend more now on 
nontraditional medical considerations than on the 
quantity of medical care available. 

Recently, the Los Angeles Times stated editorially 
what is likely to be the thrust of the future. What the 
individual does to and for himself almost certainly is the 
key determinant in health. Prevention of illness thus 
becomes to a great extent a matter of choice. What and 
how much a person eats or drinks or smokes, what care 
is taken driving a car, the amount of exercise taken — 
all influence the state of health. The most recent U.S. 
Surgeon General's report calls for a "second public 
health revolution" to improve the Nation's health. 

The success of this revolution will depend primarily 
on education and self-control rather than on massive 



new expenditures for medical technology and treat- 
ment. Now is the time to think in innovative, sweeping 
ways. Perhaps without our fully recognizing it, the 
rules of the game have changed. Our present structure 
works very well when there are plenty of resources to 
go around, enough so that even the losers get some- 
thing. We can no longer depend on that occurring. This 
new revolution recognizes our present and defines our 
future. 

The Federal health agencies will most assuredly lead 
the way in this revolution. Indeed the shock troops are 
already on the march. Tri-service regionalization and 
Federal resource sharing are already underway. State 
legislatures that face escalating health budgets are 
more frequently mandating the same sharing through 
health systems agencies and professional standards re- 
view organizations. While convenience is occasionally a 
casualty of these sharing activities, there are advan- 
tages as well, very real advantages in many instances, 
particularly for those of you in this audience. 

The vast majority of university medical centers are 
dependent on public funds. They are beginning to be 
affected by this "revolution" now. I have encouraged 
you to strengthen your university affiliations to main- 
tain excellence in our training programs, to provide us 
with the needed teachers until increased retention and 
our in-house deferment plan begins to fill the gap. The 
variety and size of our patient mix has always been the 
major attraction for academic institutions in establish- 
ing these affiliations. Now our facilities themselves are 
an attraction as well. Perhaps we have a full body CT 
scanner and the nearby university hospital does not. 
Perhaps the local VA hospital does not have a linear ac- 
celerator. We will be installing several next year. In- 
creasing interdependence will strengthen these affilia- 
tions. Exploratory talks have begun in some of our in- 
stitutions which could lead to fully integrated residency 
and fellowship programs. I urge you to take advantage 
of these opportunities and exploit them. Increased 
quality of care and excellence of training will be the 
result. 

Because our focus of attention is human life, we are, 
therefore, highly visible. Escalating costs combined 
with this visibility forces us to be accountable to friends 
and critics alike. This scrutiny is unavoidable. Since it is 
unavoidable we must turn it to our advantage. 

We must use our GME billets as the national re- 
source they are. As the number of U.S. medical school 
graduates continues to increase, the number of GME 
positions does not. When the number of graduates ex- 
ceeds the available positions, the three services' 3,500 
training billets will put us in a sellers' market. The 
escalating costs of medical school tuition will keep our 



U.S. Navy Medicine 



scholarship programs fully subscribed. Increased 
deferments will eventually swell the ranks of our 
teachers and subspecialists. If I had a solution for the 
ancillary personnel shortage, I would feel that the 
millennium had arrived. But if I must, I'll take my mil- 
lennium in small pieces, one breakthrough at a time. 

I have heard it said that no one is smart enough to be 
a pessimist. I agree. I know there's a pony somewhere. 

Despite the irritations and the frustrations, despite 
the inertia and the obstructionism, we have, on occa- 
sion, been able to confound our critics and show real 
overall progress. The reason, of course, is you and all 
your colleagues in the Medical Department, in every 
corps and in every job. 

I am proud of you. Be proud of yourselves. You are 
members of a privileged profession, serving in a proud 
tradition. In a time when caring seems so transient, 
connections so fragile, commitment so temporary, you 
remain steadfast. It is a singular honor to lead you. 



Current Status of Medical 
Department Manpower 

RADM Melvin Museles, MC, USN 
Assistant Chief for Professional Development 
BUMED MED 02 

I want to welcome you all to SAC 11 from my new posi- 
tion as MED 02. As many of you recall, I was intimately 
involved in SAC during the early 70's when I was in the 
training branch here in BUMED before HSETC was 
developed. Following that experience I spent three 
years with USUHS, two years as commanding officer of 
NRMC Jacksonville, and the last year as Medical I.G., 
having had the opportunity to inspect some 15 of our 
hospitals and medical regions worldwide. I feel 
confident that these experiences have given me the 
knowledge and ability to fulfill my new responsibilities. 
I also have come into this new code with renewed 
enthusiasm and a positive spirit recognizing that most 
of our problems are people problems. You are our 
people, you are the products of our health care system, 
you are our leaders, and you represent many of our ac- 
complishments. You also are our future. I pledge my 
office and my staff to provide you the necessary 
guidance and to do what we can to provide quality 
staffing for all of our medical facilities so that we can 
continue to offer quality health care to all of our bene- 
ficiaries. 

Before I go on to discuss some specific manpower 



issues with you, I would like to quickly review MED 02 
now that the BUMED reorganization has become a 
reality. 

I have been in my position too short a time to develop 
a full perspective and a full set of goals and objectives. 
However, my primary goal is to provide full support for 
our operational commitments and at the same time fully 
support our training programs. This has been the goal 
of our Surgeon General and he has my assurance that 
this will continue. The success of this effort is vital to 
the viability and future of our entire health care system. 

I believe we are making significant progress in the 
reality of our commitment to the operational mission. 
All members of the Navy Medical Department are 
beginning to recognize and appreciate their dual roles 
as military medical specialists and as clinical or admin- 
istrative specialists. All medical education programs 
and work experiences are now addressing themselves 
to readiness. The training and education experiences in 
peacetime must prepare us for the practice of medicine 
in all environments and in contingency situations. As 
you all know our current training programs are not ade- 
quate to meet all contingency needs. However, we are 
constantly moving closer to that end as we continually 
review our requirements and tailor educational pro- 
grams to meet them. 

This past year more of our new accessions came 
through the military indoctrination course at Newport. 
Ultimately our goal is to have all new Medical Depart- 
ment officers come through that program. 

We have implemented the advanced health policy 
and planning course (AHPPC) for senior Navy Medical 
Department officers. This course was given three times 
this year and it has been extremely successful. The 
course is specifically oriented toward operational sup- 
port, contingency planning, and the context in which 
high level leadership is exercised. We have continued 
the executive medicine course for mid-career officers 
and just yesterday we began our new seven-week 
operational medicine course for more junior officers 
who are expected to fill operational assignments. This 
course is being given in Pensacola at NAMI and will 
emphasize field medicine, preventive/occupational 
health, physical fitness, and combat medicine. 

Last year 75 percent of our GME-1 graduates were 
assigned a utilization tour. I like to look upon that year 
as a continuation of their educational experience, a 
significant part of the Navy Medical Department's con- 
tinuum of medical education, before they complete 
their own individual specialty training. 

I would ask all of you again in positions of leadership 
to embrace this philosophy. I want you to encourage 
your younger physicians to consider a tour of duty with 



Volume 70, November 1979 




RADM Museles 



CAPT Carr 



CDR Mahler (Ret.) 



the operational forces. I personally feel that this should 
be considered as an additional educational opportunity 
which augments their own specialty training. The 
young physician, either after his GME-1 year or after 
his specialty training will not only be well prepared to 
manage the varied clinical problems that come along 
but will be challenged in other areas. 

The Navy medical officer who is assigned shipboard 
duty must learn about a very unique and complex en- 
vironmental situation. He must become knowledgeable 
and conversant with preventive medicine, shipboard 
sanitation, control of physical and toxic hazards, 
environmental pollution abatement, and many other 
similar problems broadly categorized as occupational 
medicine which will tax his ingenuity and send him to 
the medical literature for solutions. 

Navy-wide programs concerning weight control, 
sight and hearing conservation, asbestos exposure, 
heat stress, tobacco, drug and alcohol abuse, and 
proper maintenance of health records are also integral 
parts of the medical officers' responsibilities to his 
command. 

The Navy medical officer today should be an expert 
in providing medical support for any situation requiring 
combat casualty management or chemical, biological, 
or radiological warfare defense whether he has duty 
aboard ship or not. 

The medical officer assigned to the operational forces 
develops a bond of friendship with his fellow officers 



and men that is unequaled in civilian life. He has a 
wonderful opportunity to become acquainted with line 
officers who are as dedicated to their profession as we 
are to ours. They strive for excellence as we do. We 
must get our Navy medical officers to broaden their 
horizons beyond medicine by talking their language 
with them. They are as proud of their titles as we are of 
ours. They are dedicated to our country in every 
respect; let's increase our visibility and truly become an 
essential part of the backbone of our great Navy. Let's 
be proud of the part we play in the defense of our great 
country. 

We continue to have excellent feedback from our 
operationally deployed medical officers and they will 
lend credence to our efforts to help solve this highly 
visible problem. With your assistance we can turn this 
around to work to our advantage. 

Statistics 

John Carr will go into more detail with his manpower 
charts but generally speaking we have every reason to 
be optimistic about the future. 

Next year we will have 280 primary care medical offi- 
cers in operational/utilization billets. That number is 
our commitment to the fleet and the Marine Corps. 

Total GME billets authorized 980, with 1,075 actually 
on board. We hope to place 260 medical officers into 
residency training. 

This year 433 scholarship students have been ac- 



10 



U.S. Navy Medicine 



cepted from over 830 applicants and they are really 
high quality; 256 will be placed in Navy internships. 
This bodes well for the future. Next year USUHS 
graduates its first class of 30 students. Approximately 
one-third of those are Navy students. 

Family practice continues to be one of our priorities. 
We have 120 family practitioners on board with a goal 
of 280. We have increased our training slots to 76. We 
are still looking forward to Bremerton as another family 
practice training hospital. 

We are planning to start two residency training pro- 
grams in emergency medicine. We need your input on 
this issue during your deliberations this week to assist 
us in developing our requirements. During my year as 
Inspector General I had numerous opportunities to 
discuss many of the issues having a negative impact on 
retention of our physicians. Duty in the emergency 
room by our specialists is another one of the key 
reasons many leave military service. We must train our 
own emergency room specialists or recruit those that 
are trained. Another option is to contract emergency 
room services but this would be prohibitively expen- 
sive. 

We have two PA training programs going again, one 
atNSHS Portsmouth, Va., and one at NSHS San Diego. 
The course is 20 weeks didactic and 32 weeks practical. 
We have 45 candidates in training now and for FY 80 
we will have 50 more. Graduates are eligible for ap- 
pointment to W-2 upon graduation. 

For the first time this year we have recruited 10 PA's 
from civilian life. Also, for the first time, we have 
assigned PA's to our carriers. All 12 carriers will have 
one PA assigned. We continue to seek other operational 
areas that can utilize their experience. Our PA's and 
nurse practitioners continue to be important additions 
to our health care team. 

Recruiting has gone particularly well this year. 
Quality has markedly improved. We have gone from 55 
percent foreign medical graduates to 10 percent. We 
had a goal this year of 276 and we have recruited 200 to 
date. We expect to be about 54 physicians short of 
authorized end strength on 1 October. 

Despite our encouraging numbers, the mix and dis- 
tribution of our clinical specialties remain serious 
problems. We continue to have serious shortfalls in 
orthopedics, radiology, general surgery, flight sur- 
geons, and to a lesser extent in neurology, urology, 
eye, and ENT. We must improve our retention as well 
as our recruiting efforts, particularly in these areas. 

We expected to have good news for you about 
variable incentive pay by this conference, but congres- 
sional delays have prevented a new bill from being 
implemented by 1 October. 



Lack of ancillary help which all hospitals have 
experienced and which is a source of adverse comments 
from our physicians continues to get attention. We still 
have not solved this problem, but we are working on it. 

Nurse Corps 

Manning of the Nurse Corps has remained at or near 
authorized strength during the past several years. 
Recruitment of qualified applicants has been excellent. 
Of the nearly 2,600 officers on active duty, 25 percent 
are male, 75 percent are female; 24 percent of the 
female officers are married and 5 percent have chil- 
dren; 83 percent of the male officers are married and 62 
percent have children. The demand for professional 
nursing care has been constantly growing due in part to 
increasing sophistication of medical capabilities. Care 
of acutely ill patients requires concentrated didactic 
preparation and expert technical skills. As length of 
hospitalization decreases for most patients, the degree 
of illness and average nursing- care-hour requirements 
increases. Other factors influencing the demand for 
nurses include the move from open bay wards to private 
and semi- private rooms, the replacement of the ward 
medical officer with physician teams, and more 
emphasis on preventive medicine and health mainte- 
nance. Expanded roles for nurses reduce the available 
billets and time for direct patient care on the staff nurse 
level. Approximately 152 nurses are assigned as practi- 
tioners, anesthetists, and chronic illness clinicians. 
Another problem is the reality that newly assigned 
Nurse Corps officers right out of school require pro- 
longed orientation programs in basic skills. Retention 
of Nurse Corps officers is good despite co-location prob- 
lems, increased numbers of dependents, pressures for 
more education, and some better opportunities in the 
civilian sector. 



Medical Service Corps 

This past year, under CAPT Nelson, has been one of 
inventory, of taking stock. CAPT Cherry Hatten, as 
deputy for Health Care and Sciences, and CAPT Vic 
Swindall, deputy of Health Care Administration have 
each been responsible for about 50 percent of MSC offi- 
cers. CAPT Roy Tandy will relieve Vic Swindall on 1 
October. CAPT Nelson's top priority issue for the MSC 
in FY 80 is to develop career planning models for all 
specialties. All MSC officers will meet the require- 
ments of our mission under standard and contingency 
conditions of operation. This has been a productive 
year. They have more billets to fill than last year due to 
expansion of such services as clinical psychology, phar- 
macy, and medical technology. We are now recruiting 



Volume 70, November 1979 



11 



for clinical audiology and social work. The require- 
ment for clinical social services has continued to in- 
crease in naval medical facilities with the expansion of 
substance abuse, family advocacy programs, and 
endeavors to decrease length of stay. Social service 
support has been an item of special interest to our 
present Surgeon General and is in keeping with CNO's 
emphasis on retention, morale, and family services. 
Program authorization for MSC to include the sub- 
specialty of social workers has been approved by the 
Naval Military Personnel Command and authority has 
been granted to recruit 13 social workers. Compensa- 
tion has been provided from other MSC specialties. 

Overall we will have 1,850 officers on board by 1 
October, 60 percent of whom are in patient care 
activities. We continue to increase emphasis on billets 
which directly support the fleet especially in the 
specialties related to preventive, occupational, and 
industrial medicine. MSC officers serve in approxi- 
mately 250 different commands. In more than 20 they 
serve as commanding officers. In more than 40 they 
serve as officer-in-charge. The health of the Medical 
Service Corps appears sound at this time. 

Hospital Corps 

The Hospital Corps has a current authorized allow- 
ance of 23,176, which is presently manned at 22,271. 
The current measure for manning levels is based on 
contingency requirements. Even with a reserve HM 
population of 20,677 personnel, we will fall well short of 
contingency commitments, should mobilization take 
place. "Nifty Nugget" revealed a definite weakness in 
the Hospital Corps' ability to augment the operating 
forces, We were unable quickly to identify enlisted as- 
sets and mobilize them. 

There is a most definite need for a total billet realign- 
ment of Hospital Corps personnel. We must consider 
the needs of the Navy, commands, and the members. 
By the proper use of our resources, we will increase the 
authority and job satisfaction of all senior and junior 
personnel. What are the true needs? 

The development of a career pattern would establish 
the foundation for a master plan for management of our 
personnel. It would also result in maximized utilization 
and cost effectiveness for all concerned. 

Overall retention thus far in the Hospital Corps is 
45.5 percent. However, this is a very deceptive overall 
figure. The breakdown is as follows: first term, 29 
percent; second term, 57.7 percent; third term, 83.7 
percent, and subsequent terms, 98.5 percent retention. 
Retention will also be improved considerably by the in- 
stitution of career patterns and proper utilization. 
Along with remaining senior petty officers, it is im- 



portant also to reduce the loss of the first term person- 
nel. 

Women are no longer restricted to CONUS and shore 
duty. In compliance with equal opportunity programs, 
Navy noncombatant billets are not labeled male or 
female. At present, 10 women of the Hospital Corps 
are serving aboard ships. The overall advancement 
picture of the women is interesting and should be of 
concern: 

Female: E-9 (0), E-8 (2), E-7 (27), E-6 (117) 
Male: E-9 (176), E-8 (407), E-7 (1,717), E-6 (2,873) 

The Hospital Corps has over the past few years been 
successful in its training programs. Formal programs 
are utilized for the training of hospital corpsmen in the 
basic school and also in over 34 different NEC's. There 
is considerable concern over the recent graduates of 
Hospital Corps "A" School, and their lack of training 
and/ or experience. The current review of the NOTAPS 
(Naval Occupational Task Analysis Program) study of 
HM "A" School is expected to reveal our weaknesses 
in this area. Many changes have taken place in our "C" 
School community and we are making considerable 
headway. 

Supervisory program in health resources manage- 
ment is a four-week course which provides training at 
NSHS Bethesda, Md., to better prepare HM/DT 
E-8/9's to assume health resources management roles 
often filled by junior MSC officers (40-48 quotas/yr.). 

Health care administration course provides nine 
months of training at NSHS Bethesda, Md., to prepare 
HM/DT E-8/9's for assignment to management level 
positions at major medical centers and medical staffs of 
major commands (6 quotas/yr.). 



Medical Corps Status Report 

CAPT John E. Carr, MC, USN 
Director, Medical Corps 
BUMED MED 21 

At the closing plenary session of SAC X we addressed 
several very serious problems concerning Medical 
Corps manpower. The shortage of orthopedic surgeons 
and medical sub specialists was discussed in depth. We 
noted that approximately 650 of our 3,400 physicians 
were eligible to either resign or retire during this 
summer and fall of 1979. That if we retained 100 of 
those 650 we would break even and stay at the same 
level of physician shortage, i.e., a deficit of 200. That if 
each one of you return to your respective hospitals and 



12 



U.S. Navy Medicine 



worked hard at recruitment and retention, we could 
appreciably improve our position. And that is exactly 
what you did and the results have been most encourag- 
ing. Active duty extensions have been high. Recruiting 
has had its best year and noteworthy is the quality of 
applicants. Our scholarship program is fully subscribed 
and our first USUHS graduates will be joining us next 
summer. And we have put more physicians in training 
while supporting our operational forces better than at 
any time in the past five years. Let me review the sta- 
tistics with you. 

Table 1 is a projection comparing our on-board 
strength at the beginning of the fiscal year to our 
authorized billets. Although we will be only about 54 
physicians short on 1 Oct 1979, please remember that 
we do not have enough billets to take care of our entire 
beneficiary populations. And of course the specialty 
mix is still a significant problem. 

Table 2 shows our Medical Corps grade distribution. 
The line is beginning to understand now why it appears 
we are top heavy in captains and commanders and this 
is not so much a problem as it used to be. They realize a 
modern health care system requires many specialists 
which necessarily means many years of training. 

Table 3 shows the Medical Corps grade distribution 
for females. We now have 223 female physicians or 6 
percent of our total force. 

Although anesthesia now has improved, we are con- 
cerned over next summer and need to address that 
problem at this meeting. Orthopedics is our worst case 
and has necessitated the implementation of many in- 
novative plans to provide coverage. We have a signifi- 
cant shortage of general surgeons while the surgical 
subspecialties are satisfactory. There is a relative 
shortage of urologists which we must address. 

We are in fair shape in respect to all of the specialties 
in Table 4 except for neurology. Our ultimate goal is for 
280 family physicians. Although generally we have 
filled the internal medicine billets, it is in the subspe- 
cialties of medicine that we still need to stress training. 

We have a relative shortage in all of the specialties in 
TableS. Although it appears we have an excess of OB/ 
GYN specialists, remember we had to close six services 
to reach this level and in reality we have a significant 
deficit. 

The most significant shortage in Table 6 is in flight 
surgery. But we have been able to fill up all of our 
classes now and our position is beginning to improve. 
For the first time, the specialty of emergency medicine 
is shown and should develop rapidly in the future. 

As far as our recruiting efforts are concerned, we 
should reach a level of approximately 200 physicians by 
1 Oct 1979. We have now been able to bring selected 



TABLE 1 


. Medical Corps 


Worldwide 


End Fiscal Year 


Authorized Billets 


On-Board 


1969 




4404 




4482 


1970 




4231 




4529 


1971 




3955 




4253 


1972 




3858 




4450 


1973 




4173 




3954 


1974 




4143 




3403 


1975 




3757 




3391 


1976 




3656 




3439 


TQ 




3696 




3628 


1977 




3651 




3524 


1978 




3636 




3467 


1979 




3625 




3571 


Data Projections 


through 


30 Septen 


ber 1979 





TABLE 2. 


Medical 


Corps 


Grade Distribution 


Rank 


2100 




2105 


Total 


VADM 


1 






1 


RADM 


13 




1 


14 


CAPT 


379 




30 


409 


CDR 


342 




145 


487 


LCDR 


203 




882 


1085 


LT 


% 




1479 


1575 




1034 




2537 


3571 


Data Projections through 30 September 1979 





TABLE 3. 


Medical Corps 






Grade Distribution - 


Females 




Rank 




2100 


2105 


Total 


CAPT 




1 




1 


CDR 




6 


2 


8 


LCDR 




8 


77 


85 


LT 




2 


127 


129 






17 


206 


223 





Volume 70, November 1979 



13 



TABLE 4. 


Navy Medical Corps Profile by Specialty • II 1 October 1979 






Authorized 


Specialty 


On 


+/- 


Specialty 


Billets 


Requirements 


Board 




Dermatology 


41 


45 


41 





Family Practice 


128 


160 


120 


- 8 


Internal Medicine 


249 


270 


261 


+ 12 


Pathology 


71 


83 


79 


+ 8 


Pediatrics 


191 


206 


203 


+ 12 


Psychiatry 


94 


120 


106 


+ 12 


Neurology 


30 


25 


17 


- 13 





TABLES. 


Navy 


Medical Corps Profile by Specialty - ID 1 October 1979 








Authorized 


Specialty 


On 


+/- 


Specialty 




Billets 


Requirements 


Board 




Ob/Gyn 




118 


120 


121 


+ 3 


Ophthalmology 




54 


52 


42 


- 12 


Otolaryngology 




53 


55 


44 


- 9 


Radiology (Diag) 




81 


121 


64 


- 17 


Radiology (Ther) 




7 


8 


4 


- 3 


Nuclear Medicine 




7 


10 


5 


- 2 


Medical Research 




63 


64 


41 


- 22 





TABLE 6. 


Navy Medical Corps Profile 


by Specialty - IV 1 October 1979 








Authorized 


Specialty 


On 


+/- 


Specialty- 




Billets 


Requirements 


Board 




Flight Surgery 




205 


290 


149 


- 56 


Undersea Medicine 




45 


47 


39 


- 6 


PCMO 




446 


461 


506 


+ 60 


Prev Med (Gen/Occup) 




30 


38 


22 


- 8 


Prev Med (Aero) 




40 


40 


37 


- 3 


Emergency Medicine 




1 


64± 


2 




GME 




980 


992 


1075 


+ 95 


Students (Aviation and Submarine) 


110 


110 


33 


- 77 





14 



U.S. Navy Medicine 



TABLE 7. FY 79 as of 6 September 


1979 




U.S. Grad 


FMG 


Anesthesiology 


6 


4 


Aviation Medicine (Fit Surg) 


8 


3 


Cardiology 


5 




Dermatology 


1 




Emergency Medicine 


1 




Epidemiology 


1 




Family Practice 


5 


2 


Internal Medicine 


16 


8 


Internship 


9 


1 


Nephrology 




1 


Neurology 


1 




Nuclear Medicine 


1 


1 


Obstetrics/ Gynecology 


5 


6 


Opthalmotogy 


3 




Orthopedic Surgery 


6 


1 


Otorhinolaryngology 


1 


1 


Pathology 


4 


1 


Pediatrics 


9 


3 


Psychiatry 


8 


4 


Pulmonary Medicine 




1 


Radiology 


6 


6 


Surgery 


7 


4 


Thoracic Surgery 


1 




Undersea Medicine 


4 




Urology 


2 


2 


General Medical Officer 


15 


11 


Totals 


125 


60=185 





physicians on active duty as commander and captain on 
an individual basis. 

Tabie 7 shows the distribution of volunteer physi- 
cians by specialty. The U.S. graduates now outnumber 
FMG (foreign medical graduates) and it is significant 
that the quality of both groups is markedly improved. 

Table 8 shows what happens to the AFHPSP gradu- 
ate. We would like to increase NADDS (Navy Active 
Duty Deferments) to about 200 per year. This would 
provide the specialists we need to augment our training 
programs and to meet requirements while preventing 
inbreeding. This effort is known as our "Arentzen 
Berry Plan" and will grow each year. 

We still have many significant problems to address 
but after reviewing this past year one cannot help but 
come to the conclusion that the worst is past and the 
future is indeed bright. 



Educational Programs and 
Scholarships for the Naval 
Medical Department 

CDR Clarence B. Mohler, MSC, USN (Ret.) 

Head, Procurement Programs and Accessions Branch 

BUMED MED 214 

I would like to say a few words about internships, 
scholarships, and USUHS (Uniformed Services Uni- 
versity of the Health Sciences). I would like to address 
these programs in perspective as they occur in the 
order of priority. 



TABLE 8. Armed Forces Health Professional Scholarship Program 


Fiscal Year 


Number of 


Navy 


Navy 


Civilian 


NADDS 


Degree Received 


Graduates 


Interns 


Residents 


Interns 


Deferment 


1975 


300 


92 


45 


30 


133 


1976 


356 


80 


52 


214 


10 


1977 


250 


172 





49 


29 


1978 


300 


219 





56 


25 


1979 


2% 


228 





37 


31 


1980 


400 


235 





65 


100 


1981 


400 


200 





50 


150 





Volume 70, November 1979 



15 



First allow me to address the AFHPS (Armed Forces 
Health Professional Scholarship Program). I put this 
program first because in the all volunteer force it is and 
will continue to be our prime source for the procure- 
ment of professional talent. 

Secondly, 1 would mention the USUHS. To be sure, 
this is a small program in comparison to the AFHPSP, 
but because of the motivation of the students at univer- 
sity, its impact upon the Medical Corps of the future is 
bound to be mighty. It is anticipated that the career 
cadre and much of our future corps leadership will 
come from USUHS graduates. Many of the earlier stu- 
dents are from the academy, the ROTC, or the active 
duty community. Because they chose the Navy early 
and because of their training, we must assume that they 
are motivated. Because of their service obligations (12 
years, exclusive of GME for an academy graduate) we 
must assume that their retention rate will be superior to 
the rate of any other group. 

Thirdly, 1 shall list internships. This is not because I 
believe GME is less important than undergraduate 
education but simply because nearly all our GME 
candidates today come from the undergraduate spon- 
sored programs. I should like to touch on a few issues 
that are of concern and interest to us all. All of you are 
aware of the high quality of the scholarship graduates 
because they rotate through your commands. However, 
you don't know about those who leave the program and 
never serve. 

First let me say that the programs under discussion 
are alive and well. We have no significant procurement 
problems filling all programs with outstanding candi- 
dates. However, we are dealing with humans and 
humans are not always predictable. In our selection 
process we do goof from time to time. 

The attrition rate for the scholarship program is 
minimal. Since 1973, the program has produced nearly 
2,000 doctors, not to mention dentists, psychologists, 
and optometrists. The number of dropouts for all causes 
has been about 90. This gives us an attrition rate of less 
than five percent. I believe you will find this compares 
very favorably to the overall attrition rate that applies to 
all students in all medical schools. 

Students leave our programs for several reasons. The 
most significant is academic failure followed by change 
in motivation, sickness, death, unacceptable behavior, 
moral turpitude, dependency, and conscientious objec- 
tion. All these are legitimate reasons for leaving the 
program, and as a career military officer, I can accept 
them without question except for conscientious objec- 
tion. Almost without exception, the decision to become 
a conscientious objector comes at the end of the educa- 
tional cycle, after all program benefits have been re- 



ceived, and when the Navy has no opportunity to re- 
verse the scholarship and obtain a doctor replacement 
by giving it to another worthy candidate. 

What happens to the scholarship benefits? Does the 
dropout have to pay them back? The answer to that is 
yes and no. Our authority to recoup scholarship pro- 
gram benefits is limited to those cases where the indi- 
vidual fails to serve his obligation as a result of action 
not initiated by the government. This limits our recoup- 
ment authority to those cases mentioned in the latter 
categories such as dependency, moral turpitude, and 
conscientious objection. 

Dependency, so far, has been limited to females who 
are pregnant or have children. Of course, here it is 
quite clear that the government had nothing to do with 
the action and the money must be paid back. However, 
here I might say that we have one young man who has 
discussed with us the possibility of a dependency dis- 
charge because he is divorced and is a single parent 
who has custody of a minor child. That was several 
months ago and so far we have not heard further from 
him. Moral turpitude has involved only male students 
who have become involved in criminal behavior and/or 
drug abuse. 

Let me return to money for a moment. You will note 
that we are not reimbursed from some categories. Here 
we could say that the government had nothing to do 
with the action that caused a student to fail academical- 
ly or change his motivation for medicine. Why can't we 
get the money back? Almost without exception, these 
students have informed the Navy that they wish to 
serve their obligations in another officer corps as re- 
quired by the contract. Sometimes another corps has a 
need and the officer so serves. Sometimes, there is no 
need, so the only alternative is discharge. In this in- 
stance it is held that the action is initiated by the 
government because the individual volunteered and we 
won't take him. 

The oddities that I have noted here make it appear 
that we are wasting our money. Nothing could be 
further from the truth. There are very few students who 
explore pathways for circumventing their obligations. 
The number is so small that an understandable percent- 
age could not be calculated. By far, the medical stu- 
dents we are sponsoring today are red-blooded Amer- 
icans who are motivated, loyal, honest, and intelligent. 
I can honestly say that one of the highlights of my day is 
when I have an opportunity to assist one of these young 
men or women with their transition from civilian to 
military life. 

For internships to begin in 1980, we have 256 billets. 
At this time we have 340 completed applications. We 
have about 20 applications that may be complete before 



16 



U.S. Navy Medicine 



SAC is over. I realize this number of applications, as 
compared to billets, does not give us an optimum in 
selection possibilities. It would be better if we had two 
candidates for every billet. However, it must be real- 
ized that these are top quality candidates. They have 
already been screened once in the selection process for 
scholarships. 1 am most confident that on 1 July 1980 
the group of interns you will commence training will be 
as good as interns anywhere. 



Navy Urology: A Status Report 

CDR S.M. Steele, Jr., MC, USN 
Chairman, Department of Urology 
NRMC Portsmouth, Va. 

This has been an encouraging SAC with respect to the 
quality of our urology applicants and especially regard- 
ing the numbers of physicians we are told will be 
coming into the system three, four, and five years down 
the road. This encouragement does not, however, alter 
the fact that Navy urology is having significant prob- 
lems. Of all our difficulties, the one which is most crip- 
pling is our support personnel or, better stated, our lack 
of support personnel, especially urology technicians, 
NEC 8486. Technician staffing is painfully inadequate 
number-wise and the maldistribution is worse. This 
problem is not a new one but has been specifically ad- 
dressed by Urology Committee SAC reports in 1970, 
'72, '77, and '78. We also recognize that the problem is 
not limited to urology, as the general topic of support 
personnel for specialized services was addressed at the 
closing plenary session in 1976. The significance of this 
problem was underlined by the participants in the Sur- 
geon General's Graduate Medical Education Confer- 
ence of January 1979 as they wrote "adequate quality 
and numbers of professional, technical, secretarial, and 
clerical support personnel" ranks as one of the four 
factors of paramount importance influencing decisions 
to make a career of the Navy. 

We also have hard, objective evidence that we are 
understaffed and that our claims for numbers of techni- 
cal and civilian personnel are justified. This documen- 
tation is found in the Work Center Staffing Standards 
Report published in October 1978 by the Navy Man- 
power and Material Analysis Center, Atlantic. We are 
not in 100 percent agreement with the standards but 
their implementation would go a long way toward 
easing our present situation. 

Maldistribution, particularly the assignment of fully 
trained urology technicians to billets which provide no 




CDR Steele 

urological support, is the hardest aspect of our techni- 
cian shortage for us to understand. The July printout 
for 8486's identifies 65 technicians, which is 12 less 
than the present number of billets. Of those 65 techni- 
cians, 11(17 percent), one out of every six, are assigned 
to billets which are unrelated to urological support. 
Eight of these technicians are assigned to medical 
centers without urologists, two at Corpus Christi, two at 
Memphis, and four at Philadelphia. Despite telephone 
calls, naval messages, and assurances to the contrary, 
one new technician graduate was just sent from San 
Diego to Yokosuka, which has no urologist. Despite my 
efforts, a new graduate was sent to Philadelphia in 
July. About six months ago a technician reenlisted and 
was sent from Oakland to Memphis. His first set of 
orders was to Biloxi, Miss., which has not had a 
urologist in the memory of anyone on the Urology Com- 
mittee. Oakland, one of our training programs that has 
billets for five technicians, really needs seven, but has 
only two on board and new graduates continue to re- 
ceive orders to hospitals without urologists. We simply 
do not understand this. 

In addition to this, our needs with regard to training 
and stability are becoming more acute due to the 
tremendous technologic advances in urology over the 
past five years. Training and staffing which were ade- 
quate in 1974 no longer suffice. We now have instru- 
ments and perform studies on a routine basis which 
were infrequently performed in investigative centers as 



Volume 70, November 1979 



17 



little as five years ago. Navy trained urology 
technicians undergo six months of formal training 
which, at our best guesstimate, costs a minimum of 
$10,000 per trainee. This six months provides back- 
ground and practical experience, but it takes an addi- 
tional 12 months of duty before one has a really good 
technician. Some technicians graduate with the rate of 
HM2. Urology technicians lose their NEC when they 
are advanced to HM1. It is neither time nor cost effec- 
tive to train individuals and then strip them of their 
NEC when they have become proficient and valuable 
members of the health care team. Defenses raised for 
this process are: What can they do on sea duty and 
what is their mobilization role? There are at least two 
solutions to these problems: Urology technicians are 
easily cross trained as OR technicians, many already 
function as OR technicians in their present billets, and 
some first assist in major procedures such as nephrec- 
tomies and pyeloplasties. Urology technicians are also 
highly skilled in urographic procedures and are readily 
cross trained to perform most radiographic studies. 
This identifies two billets which urology technicians 
could fill on a carrier, LKA, LPH, or similar ship or with 
the Fleet Marine Force. With respect to NEC, the 
second billet identified, 8452, the radiology technician, 
retains the NEC through E-7. 

The foregoing provides objective evidence that our 
requests for staffing are well founded. We believe we 
have demonstrated the inefficiency (both in time and 
dollars) of being advanced out of NEC 8486 at the E-6 
level. We have identified mobilization/sea billets which 
the 8486 can fill, one of which retains its NEC through 
E-7. We believe that retention of NEC 8486 through E-7 
is justified on the basis of today's state of the art, time 
and cost effectiveness, and the multiple roles these 
technicians can fill in the event of mobilization. 

We believe that the foregoing proposed solutions to 
our most pressing problem are feasible, workable, and 
realistic. We fully understand that certain numbers, 
billets, and assignments are regulated by policies, 
laws, and/or offices not subject to control by BUMED. 
We are asking for help from BUMED and/or HSETC. 
Help us to initiate whatever action is needed to realign 
the billets so that urology technicians will not continue 
to be assigned to hospitals without urologists while 
those with urologists and even with training programs 
are less than 50 percent manned. Help us to initiate the 
action needed to retain our technician rating through 
E-7. Help us initiate the action needed to raise techni- 
cian staffing to needed levels. 

In closing I can only say that I sincerely hope one of 
our successors will not have to stand up here in 1985 
and repeat what my predecessors and 1 have had to say. 



Recommendation Made as 
Chairman of the SAC XI Opera- 
tional Medicine Committee 

RADM C.H. Lowery, MC, USN 
Assistant Chief for Health Care Programs 
BUMED MED 03 

The Operational Medicine Committee recognizes the 
impressive emphasis which has been placed on the 
operational portion of Navy medical education and 
training continuum during the past three years. The 
results of these efforts are now being recognized. Ap- 
plicants to graduate medical programs are demon- 
strating higher degrees of maturity, professional 
knowledge, and career orientation. Deficiencies re- 
maining are those related to a real lack of professional 
medical leadership being provided to these junior medi- 
cal officers during their early medical learning experi- 
ences outside the traditional medical center environ- 
ment. To provide this "role model" leader, we need to 
place greater emphasis on the importance of expanding 
operational opportunities to our mid and senior grade 
career medical officers. This thrust, if met willingly and 
with an appreciation for its potentially positive impact 
on the professional development of our future career 
medical officers, will also serve to enhance the capabili- 
ties of these developing leaders for both contingency 
requirements and teaching contributions to the Medical 
Department of the future. 

To paraphase this recommendation, we believe there 
is a definite need to improve the quality of our medical 
leadership in the field of operational medicine and to 
provide favorable "role models" for our junior medical 
officers who are assigned to operational medical billets. 
In addition, assignments of senior grade medical offi- 
cers to positions of leadership within operational medi- 
cine and their positive acceptance of their responsibili- 
ties should be considered as a means of career enhance- 
ment for our career officers. 



Findings of the Otolaryngology 
Committee 

CAPT Clarence G. Strom, MC, USN 
Chief of Service, Otolaryngology 
NRMC Oakland, Calif. " 

During the deliberations of the Otolaryngology Com- 
mittee we found that we did not find, could not find out 



18 



U.S. Navy Medicine 




CAPT Strom 

who, where, why, and when individuals were being or 
had been deferred for outside training. Many of the 
other committees were apparently faced with the same 
difficulty. We feel that it is of utmost importance for 
these applicants to be routed through these SAC com- 
mittees for consideration regarding deferment and 
placement. Though we agree with the Surgeon Gen- 
eral's "Berry Plan" we feel it is folly to leave openings 
in Navy programs, especially when they are of such 
high quality and into which so much time, effort, and 
money have gone. To make any judgments or plans as 
to future needs is impossible if you don't know where 
these individuals are. 

Secondly, the same would hold for "trained" indi- 
viduals applying to the Navy for the First time or coming 
back into the service after a period of active duty. A few 
phone calls to the program chairman concerning these 
people would help the Bureau immensely in placement. 
The individuals might be good both for teaching and 
nonteaching positions. Also, program chairmen might 
have information regarding the individuals which 
would suggest that they not be placed in the service at 
all. 

Thirdly, the attrition rate in otolaryngology is high. 
An estimate of 10 percent of persons remaining beyond 
their obligated time is considered optimistic. We feel 
that 66 otolaryngologists are required in the Navy at the 
present time; 43 are now on active duty with an esti- 
mated loss of 16 to 20 by July 1980; 8 will be produced 
by Navy residency programs, giving at the most, 30-35 



on-board by FY 80, or 50 percent of required strength. 
Estimated manning for FY 81 and 82 are 30-40 percent 
at the most. Such a loss not only has ramifications on 
patient care throughout the Navy, but has a marked 
impact on specialty training programs and especially 
family practice training programs. Included in the 
potential losses within the next three years are the 
majority of present and potential program chairmen of 
the teaching programs in the Navy. As one of our com- 
mittee members said, never has he had a job that he 
enjoyed more that paid so little compared with the re- 
sponsibility that it carried. Obviously, the pay bill (the 
Uniformed Services Health Professionals Special Pay 
Act of 1979) is of extreme importance. 

Finally, I would like to say something about Naval 
Hospital, Oakland and I feel that the ideas are shared 
by other department members at Oakland. 

NRMC Oakland has residency programs, program 
chairmen, and staff members that rank with the highest 
in the country and this includes the majority of the uni- 
versity training programs. However, as you know, 
rumors run rampant through interns and residents. 
Persistent innuendo concerning the publicity Oakland 
received three years ago and continued rumors con- 
cerning the closing or non-closing of Oakland Naval 
Hospital or Letter man Army Hospital badly affect 
resident and intern recruitment. We want you to know 
and to tell interns and residents and medical students 
that you interview that Oak Knoll is alive and well and 
not living under an assumed name in Oakland. 

Protection of Human Subjects 

CDR Harold M. Koenig, MC, USN 
Department of Pediatrics 
NRMC San Diego, Calif. 

Points I am going to make today do not deal just with 
pediatrics. They really cover all of us who are interested 
in doing any kind of research that has to do with human 
subjects who may at the time that the research is being 
done be in a compromised state of mental health or 
ability to make decisions. The reason this has come up 
is because of SECNAV INSTRUCTION 3900.39A dated 
March 1978. 1 will read a portion of this instruction that 
pertains to our problem: 

"Third party consent (i.e., that given by parents, 
legal guardians, next of kin, or other legally authorized 
third party representatives) may be used only when the 
prospective human subject is factually capable of giving 
informed consent. Persons who are not factually 
capable of giving informed consent shall not be used as 
subjects." 



Volume 70, November 1979 



19 



The term "factually capable" is not defined in the 
instruction, nor is there universal agreement on who or 
at what age one is "factually capable" of giving 
informed consent. The committees for Protection of 
Human Subjects at two of our largest naval medical 
centers have refused to act on any research protocols 
involving children since becoming aware of this instruc- 
tion. The impact has thus been primarily on pediatric 
research, but careful scrutiny and rigid interpretation 
of the instruction would suggest that research cannot 
be conducted on any individual in an altered state of 
consciousness. 

Clarification of how this instruction was to be inter- 
preted by local committees for the protection of human 
subjects was requested from the Surgeon General. His 
reply was that this instruction represented "a conscious 
decision to limit research and clinical investigation to 
minors who are capable of giving informed consent" 
and added that "this may be an issue deserving further 
discussion and deliberation with a view toward 
modifying the instruction." The purpose of this state- 
ment is to attempt to obtain further clarification of and 
possibly modification of SECNAV INSTRUCTION 
3900, 39A. 

The need for further research in children is indis- 
putable. Without research, there is no progress. Estab- 
lished methods can no longer be challenged and tested 
by the scientific method. Without research, our training 
programs will become apprenticeships where mistakes 
are compounded by being retaught. 

In 1974, Congress passed the National Research Act, 
establishing a National Commission for the Protection 
of Human Subjects of Biomedical and Behavioral Re- 
search. This commission, composed of outstanding 
representatives from the legal, religious, scientific, and 
minority ethnic communities, has drafted 10 recom- 
mendations regarding the protection of children who 
are used as subjects of scientific research. These rec- 
ommendations represent the most thoughtful analyses 
of the issue of protection of the rights of human sub- 
jects ever accomplished. It is anticipated that these 
recommendations will become law within the year. 

We would like to request that the Surgeon General 
seek further clarification from the Secretary of the Navy 
as to whether or not research in children may continue 
within the Navy Medical Department under the present 
instruction and to request that the recommendations of 
the National Commission be adopted into the SECNAV 
instruction regarding the Protection of Human Sub- 
jects, so children who are subjects of biomedical and 
behavioral research in the Navy Medical Department 
are afforded the same protection that other children in 
this nation will receive. 



QUESTION AND ANSWER SESSION 



Participants answering questions from the floor: 

VADM Willard P. Arentzen 

RADM Almon Wilson, Commanding Officer, HSETC 
RADM Frances T. Shea, Director, Nurse Corps 
RADM Melvin Museles, Assistant Chief for Profes- 
sional Development 
CAPT Paul D. Nelson, Director, Medical Service Corps 
CAPT John E. Carr, Director, Medical Corps 
CDR Clarence B. Mohler, MSC (Ret,), Procurement 

Programs and Accessions Branch 
HMCM Stephen W. Brown, Director, Hospital Corps 



Q: What is the present BUMED policy on the stability 
of tours? 

CAPT Carr: As far as the Medical Corps is concerned, 
the days of moving people for the sake of moving them 
are over. This has been the thought of the Surgeon 
General for some three years now. There has been in- 
creased stability. There is no doubt that places like San 
Diego and Bremerton are very desirable places. Where 
we have the problem are places like Adak, Keflavik, 
and Guantanamo. What we try to do is minimize the 
tour in places that are less desirable and maximize the 
tour in other places. 

RADM Museles: I generally agree with that policy but 
we can't develop one group of people that is immovable 
and another group that is movable. We have to keep 
that in mind when we look at retention of individuals in 
various duty stations that are considered good assign- 
ments. We do have those duty stations that are con- 
sidered less than desirable. Again, some of these are 
based on attitude. We may be able to improve the atti- 
tude of those going to what are perceived as less than 
desirable duty stations. Whether you believe it or not, 
some of those assignments are career enhancing. We 
cannot get into a position where we develop two groups 
of people. We certainly do encourage longer tours. It's 
cost effective and in many respects it meets our training 
needs. Yet we must continue to revitalize our training 
programs by moving new people in periodically. 



Q: Most of us who recognize the shortage of Hospital 
Corps personnel are extremely concerned about it. It's 
been a Navy policy in the past that when there is a 
critical shortage in a particular element of enlisted 
personnel, bonus plans and other means are used to 



20 



U.S. Navy Medicine 



help correct the situation. Has there been any thought 
to using these techniques for the Hospital Corps? 

HMCM Brown: Yes. We have approached the detailers 
and those involved with incentive programs. We realize 
our shortfall. Again, money is the problem. I'm looking 
at other ways we can improve our retention. This has 
been a problem for a long time, at least 10 years. Now is 
the time to do something about it. It' s up to all of us to 
increase retention. We will continue to push for more 
incentive and education programs. 

Q: In your opinion, what is the key problem in retain- 
ing corpsmen beyond their initial enlistment? 

HMCM Brown: It's a case of their feeling wanted and 
having the opportunity to advance. We have to utilize 
these people and give them meaningful jobs. We must 
train them and then use the talent we've trained. 

VADM Arentzen: Let me say something about the 
enlisted side of the house. Navy-wide, if you take the 
various corps, we are in far better shape than some of 
the electronic technicians, bosun's mates, and so forth 
aboard ship. You can even say the same thing about the 
line officer today regarding positions. The retention 
rate of pilots is as low as it's ever been. The airlines are 
signing up more and more every year. 

Our enlisted people have no upward mobility and 
that's been one of my goals since taking over. That's 
why you see HMCM Brown sitting here to head the 
Hospital Corps. These people are smart, ambitious, 
they want to be trained. When I wanted to put the 
master chiefs into the long course here in health care 
administration, I was told that you don't educate an en- 
listed man, you train him. Well, I disagree. These men 
want education today and if we don't give it to them, 
they will get it on the outside. 

In your hospitals, look around and see where corps- 
men are being wasted. It's up to you to put pressure on 
your skippers to get those corpsmen out where they 
belong. You will find that although the wards are short 
of corpsmen, patient affairs is not short nor is the 
supply department short of corpsmen. Get to your COs 
and get them to use these people where they are 
needed. 

Another thing that will keep them in is a "Thank 
you" and a pat on the back for a job well done. 

Q: As our resources dwindle, there seems to be less 
time for physicians on the wards to devote to educating 
corpsmen and also taking care of patients. The training 



could probably be done better in the corps schools. 
Perhaps the corps schools should be lengthened. 



RADM Museles: I think you're right. Our corps schools 
need to be lengthened. We need to give them more 
training and experience. Higher authority has curtailed 
the length of training. We fought that battle in the past 
and will continue to fight it in the future. It is our 
schooling that has suffered over the years. And it's true 
of our medical schools as well. Our doctors need an 
internship now more than ever. It's true of the Nurse 
Corps. I think their schools have gone the same way — 
more education and less practical experience. When 
they come out, they don't have an opportunity for an 
internship, but they need one too and they have to 
create one which uses up their resources. 

Our Medical Service Corps officers are coming out 
with masters and Ph.Ds. They get into the system and 
they also need experience, 

I don't know the answers to all these problems but I 
think we have to go back and look at our education and 
training programs and make them more relevant to our 
needs. 

RADM Wilson: The problem of training corpsmen has 
been with us for 100 years. In the old days a corpsman 
used to go to corps school for 16 weeks. He then went to 
some hospital and stayed on the ward for 6 months. 
Some hard-charging LCDR or nurse grabbed him when 
he went aboard and kept him there until he was a pretty 
good ward corpsman and then he moved on. It was also 
the day of the ward medical officer who had some inter- 
est and some time and taught the corpsman. Those 
days are gone. 

Today we are looking at a completely different situa- 
tion. The problem is how much is enough at corps 
school? No one can walk out of civilian life and into 
something as complicated as the medical world and in 
8, 10, or 12 weeks get a working knowledge that will 
enable him to do things effectively. Therefore, no 
matter how long you put a corpsman in "A" school, be 
it 8, 10, or 16 weeks, he or she will still require some 
kind of supervised clinical experience before they can 
adequately utilize what they know. 

Secondly, how much do you want them to know when 
they come out of "A" school? Do you want them to 
come out third class? Specifically, what do they need to 
know? We are now trying to find out what they know 
and to find out what customers expect them to know. I 
think there may have been a failure of communication 
between us the trainers and you the customers. We 
may not have communicated to you what skills they do 



Volume 70, November 1979 



21 



possess and what level of understanding we have tried 
to instill in them. You may be expecting too much, or 
we may be wrong on our end of it. 

The prospect of getting an "A" school corpsman an 
assignment on a ward after corps school is increasingly 
difficult because of money. It amounts to PCS money 
and the fact is that the population in our hospitals is 
lower these days than it used to be. We don't have the 
inpatient load we once had to justify training all that 
many corpsmen for all that many weeks. 

If any of you have ideas about specifics that you want 
"A" school corpsmen to know, I wish you would com- 
municate your thoughts to us. We are trying desperate- 
ly to get some kind of reasonable profile that represents 
the product of our corps schools. 

Q: Once upon a time the Uniformed Services Univer- 
sity was supposed to be that — a total university. It was 
to include ancillary medical fields, nursing as well as 
medical. It seems that if that could be organized, we 
would be able to train nurses and you could do it in a 
milieu where they could be well grounded in the mili- 
tary hospital system. I wondered if that concept has 
been totally abandoned or if there is any prospect for it 
in the future? 

RADM Shea: The last I heard, this program had been 
abandoned because of the cost. The cost to put nurses 



through the Uniformed Services University would be 
prohibitive. There are no federally funded programs at 
the present time for the military, except the out-service 
programs that we ourselves use to educate nurses. The 
funding of registered nurses in out-service education — 
that is for the civilian nurse to go to school — has been 
cut back radically. HEW grants have been cut and I just 
don't see, in the immediate future, that there will be 
more funds appropriated for the education of nurses. 

As far as the Uniformed Services University is con- 
cerned, I don't think it would solve our problems to any 
great degree because the problem we have right now is 
not getting nurses. We can get them; we could get 
more than 2,600. What we need are the billets. I think 
what we really have to do is to look at our situation to 
see where our billets are — and we are doing this — and 
to put them where they are best needed. 

This doesn't answer your question except to say that 
I don't think that we will be going to the Uniformed 
Services University. If we do, the numbers of students 
would be minimal, maybe 30 per each service for class. 
And that would be five or six years down the road. 
What we need are billets. Every time we add more 
nurse anesthesia billets or add more nurse practitioner 
billets, that comes out of the total pie. We just have to 
decide what we want and where we want to utilize 
them. We must work with what we have and train what 
we have. That's reality. 



Navy Rafters Save a Life 



A rafting trip turned into an un- 
expected real life emergency for 
several NRMC Oakland person- 
nel who participated in the recent 
off-duty outing. 

On 22 Sept 1979, Center mem- 
bers beached their rafts for a 
short rest near Coloma, Calif., 
after successfully negotiating 
"Troublemaker Rapids." They 
were out of the rafts and ashore 
when an unidentified man stand- 
ing on a bridge above the river 
called out that he had spotted a 
body floating in the water. Corn- 
merical guides accompanying the 
group plunged into the water and 



LSU11S~U LIU 



lIVLUlli f* •*\Sltlt41l 411 liwi 



early 20s, to the bank. 

The guides shouted across the 
river to the medics for help and 



physicians CDR Charles C. Spiel- 
man, LT Bonnie M. Potter, 
LCDR Richard R. Imes, and LT 
Paul Garst, together with nurses 
LCDR Marty Sherrard and LT 
Penny Turner, immediately re- 
sponded, paddling by raft across 
the turbulent waters to begin re- 
suscitation efforts while MSC 
officer LT Bruce Custis took off 
to notify the Park Ranger. 

One of the attending Navy 
physicians said the victim ap- 
peared dead. "She had no pulse 
and no blood pressure, and of 
course, she had inhaled a lot of 
water into her lungs." Neverthe- 



W Qiril 



nhnct^iinr 



nurses kept up the emergency 
treatment for at least another 15 
to 20 minutes. 



Meanwhile, the Park Ranger 
called the California Highway Pa- 
trol, which sent paramedics and 
a helicopter to the scene. With 
the arrival of the paramedics, the 
Navy doctors had access to medi- 
cations and a monitor, which 
showed that the victim had 
resumed breathing and estab- 
lished cardio-rhythm. Their re- 
suscitation efforts had proven 
successful. 

The young woman was placed 
aboard the helicopter and, with 
Dr. Spielman at her side, was 
transported to the Marshall Hos- 
pital in Placerville. The Navy 

/"•arjHinlnrnct nccicfraH i»m*»ro*»Tmv 
~e~- "— o j 

room physicians there until the 
patient was stabilized and trans- 
ferred to a special care unit. 



22 



U.S. Navy Medicine 



CUT ALONG THIS LINE 



NOTES 



ROSTER— 1 SEPTEMBER 1979 



Following is a list of staff" medical and dental of/Jeers of major fleets and forces; 
district medical and dental officers; commanding officers; executive officers; direc- 
tors of administrative services: directors of clinical services; chief nurses of Medical 
Department activities; division surgeons and dental officers of Marine divisions. 
Marine aircraft wings, and Marine brigades. 



C1NCPACFLT/CINCPAC (ADDU) RADM D.E. BROWN, JR., MC, USN 

C1NCPACFLT CAPT N.D. WTLKIE. DC, USN (ADDU) 

AO CAPT C. WIMEERLY. MSC, USN 

CLNCLANTFLT/C1NCLANT(ADDU) RADM J.R. LUKAS, MC. USN 

CINCLANT/CINCLANTFLT/CINCWESTLANT RADM J.B. HOLMES. DC, USN 

C1NCLANTFLT AO CDR B. OZMENT, MSC, USN 

SACLANT AOCDRW. BRANSCUM. MSC. USN 

CINCUSNAVEUR CAPT A.P. BELMONT, MC, USN (ADDU) 

CAPTR.P. MORSE. DC. USN (ADDU) 

COMNAVFORJAPAN CAPTB.L. JOHNSON. MC, USN (ADDU) 

CAPT E.T. WTTTE. DC, USN (ADDU) 

COMNAVLOCPAC RADM D.E. BROWN. JR., MC, USN (ADDU) 

AOCDRC.A. ROPER. MSC. USN 

COMNAVAJR1ANT CAPT D.J. LETOURNEAU. MC, USN 

CAPT K.F. BATENHORST. DC. USN (ADDU) 

COMNAVAIRPAC CAPT F.E. DULLY, MC. USN 

CAPT A.L. DAVY. DC. USN (ADDU) 
AO LCDR C. SCHMUTZ. MSC, USN 

COMSUBLANT , CAPT 8.J. BLANltENSHlF. MC. USN 

COMSUBPAC CAPT W.C. M1LROY, MC, USN 

CAPT N.D. W1LKIE. DC. USN (ADDU) 

CNTECHTRA (NAS MEMPHIS. TN) CAPT C:W. BRAMLETT. MC. USN (ADDU) 

CAPT D.G. GARUER. DC, USN (ADDU) 

CNATRA (NAS CORPUS CHR1STI, TX) CAPT T.J. TRUMBLE, MC, USN (ADDU) 

COMNAVSURFLANT CAPT W.M. PHILLIPS, MC, USN 

CAPT J.P. WILLIAMS. DC, USN (ADDU) 

COMNAVSURFPAC CAPT D.C. GOOD, MC. USN 

CAPT R.E. THOMAS, DC, USN (ADDU) 
AO LCDRR.W. BARNHILL. MSC. USN 

COMNAVFORCARIB/COMANTDEFCOM CAPT P.C. GREGG, MC, USN (ADDU) 

CAPT D.E, BARLOW. DC. USN (ADDU) 

COMFA1RMED , CAPT J.A. MCKINNON, DC. USN (ADDU) 

COMTRAWING 4 CAPT A.D. SORENSON. DC. USN (ADDU) 

FOURTH NAVAL DISTRICT DMO CAPT R.E. TOBEY. MC, USN (ADDU) 

DDO CAPT A.F. REID. DC, USN (ADDU) 
AO LT J.N. GALL1S. MSC, USN (ADDU) 

NA VREGMEDCLIN1C. PORTSMOUTH, NH CO CDR D. W. REEVES. MSC, USN 

XQ LCDR R. REL1NSKI, MSC, USN 

SR NURSE CDR M. BRAXMAN. NC. USN 



NAVREGMEDCEN, NEWPORT. HI. 



NAVREGDENCEN, NEWPORT, HI. 



NAVSUBMEDCEN, NEW LONDON, CT. 



NAVSUBMEDRSCHLAB, NEW LONDON, CT. 
NAVREGMEDCEN, PHILADELPHIA, PA 



NAVREGDENCEN, PHILADELPHIA, PA 

NAVMEDMATSUPPCOM, PHILADELPHIA, PA. 

FIFTH NAVAL DISTRICT 

NAVREGMEDCEN, PORTSMOUTH, VA 



NAVAL SCHOOL OF HEALTH SCIENCES DET, 
PORTSMOUTH, VA 



NAVREGDENCEN, NORFOLK. VA. 



COCAPTN.R. RAFFAELLY, MC, USN 
DCSCAPTR.T. LARSEN, MC, USN 
DAS CDR N.K. OWENS, MSC, USN 
CH NURSE CAPT P, ELSASS, NC. USN 

CO CAPT W. A. PETERSON, DC, USN 

DCS CAPT R.B, ANNIS. DC, USN 

DAS LT J.C. WANAMAKER, MSC, USN 

CO CAPT L.H. SEATON, MC, USN 

DCS CAPT R.B. JOHNSON, MC, USN 

DAS LCDR M.S. DUNY, MSC, USN 

CH NURSE CAPT N. LUNDQUIST, NC, USN 

CDR R.A. MARGUL1ES, MC, USN 

CO CAPT R.E. TOBEY, MC, USN 
DCS CDR CT. CLOUTIER, MC, USN 
DAS CAPT H.S. RUDOLPH, MSC, USN 
CH NURSE CAPT C. SHEA, NC, USN 

CO CAPT A.F. REID, DC, USN 

DCS CAPT H.E. FREEBURN, JR., DC, USN 

DAS LT O.J. SANTORE, JR., MSC, USN 

CO CAPTO. STALLINGS, MSC, USN 



DMO RADM G.E. GORSUCH, MC, USN (ADDU) 
DIRDENACTYS RADM J. B. HOLMES, DC, USN (ADDU) 

CO RADM G.E. GORSUCH, MC, USN 

DCS CAPT J.N. RIZZI, MC, USN 

DAS CAPT D.E. SHULER, MSC, USN 

CH NURSE CAPT M.J. NIELUBOWICZ, NC, USN 



OICCAPTB.A. MCKAY, NC, USN 
AO LT G. MUEPHREE. MSC. USN 

CO RADM J.B. HOLMES, DC, USN 

DCS CAPT A. HERR, DC, USN 

DAS CDR C.A, WES0L0WSK1. MSC. USN 



NAVAL BASE, NORFOLK, VA RADM J.B. HOLMES, DC, USN (ADDU) 



NAVAL OPHTHALMIC SUPPORT & TRAINING 
ACT, YORKTOWN, VA 



NAVHOSP, CHERRY POINT, NC . 



NAVREGMEDCEN, CAMP LEJEUNE, NC . 



NAVREGDENCEN, CAMP LEJEUNE, NC . 



NAVAL ENVIRONMENTAL & PREV MED 
UNIT2, NORFOLK, VA 



NAVAL ENVIRONMENTAL HEALTH CENTER, 
NORFOLK, VA 



SIXTH NAVAL DISTRICT 

NAVREGMEDCEN, CHARLESTON, SC . 



CO CAPT J. G. WILCOX, MSC, USN 

CO CAPT D.E. STILL, MSC, USN 
DCS CDR E.J. WOLSKI, MC, USN 
DAS LCDR J.W. BALDWIN, MSC, USN 
CH NURSE CDR H. HOLBROOK, NC, USN 

COCAPTJ.L. HUGHES, MC, USN 
DCS CAPT R.R. PALUMBO, MC, USN 
DAS CDR J.E. DEWITT, MSC, USN 
CH NURSE CAPT E. CARSON, NC, USN 

CO CAPT N.K. LUTHER, DC, USN 
DCS CAPT T.L. WHATLEY, DC, USN 
DAS LCDR R.J. LINDSAY, MSC, USN 



OIC CAPT H.J. CANDELA, MC, USN 
AO LT H.T. BROWN, MSC, USN 



CO CAPT J. CARUSO, JR., MC, USN 

DMO CAPT l.J. WOODSTEIN, MC, USN (ADDU) 
DDOCAPTR.G. GRANGER, DC, USN (ADDU) 

CO CAPT I.J. WOODSTEIN, MC, USN 
DCS CAPT W.L. BRANNON, JR., MC, USN 
DAS CDRG.M. ELLIS, MSC, USN 
CH NURSE CAPT M. YOUNG, NC, USN 



U.S. NAVREGDENCEN, SUBIC BAY, RP . 



... CO CAPT B.F. TAYLOR. DC, USN 
DCS CAPT J.F. LESSIG, DC, USN 
DAS LCDR N.E. CARROLL. MSC. USN 

U.S. NAVMEDRSCHUNIT2,MANTLA, RP CO CDR W. SCHROEDER, MSC, USN 



SPAIN 

U.S. NAVHOSP, ROTA . 



CO CAPT J.E. WILSON, MC. USN 
DSC CAPT A.R. PEARSON, MC, USN 
DAS CDR C.A. HARTMAN, MSC, USN 
CH NURSE CDR B. WEIDT, NC, USN 



HEADQUARTERS MARINE CORPS AND FLEET MARINE FORCE 

HEADQUARTERS, U.S. MARINE CORPS CAPT G.E. GIFFIN IB, MC, USN 

CAPT F.R. RUL1FFS0N, DC, USN 
AO 

HEADQUARTERS, FMF ATLANTIC CAPT H.S. TROSTLE, MC, USN 

FORDO CAPT R.S. DAVISON, DC. USN 
AO LCDR R.F. COXE. MSC, USN 

SECOND MARINE DIVISION SURGEON CAPT R.M. LEHMAN, MC, USN 

SECOND FORCE SERVICE SUPPORT GROU P SECOND DENCO CAPT R. P. FALCONE, DC, USN 

SECOND FORCE SERVICE SUPPORT GROUP 22ND DENCO FORTRPS CAPT J .S. KITZM1LLER. DC, USN 

SECOND MARINE AIRCRAFT WING CAPT D.S. ANGELO, MC, USN 

SECOND FORCE SERVICE SUPPORT GROUP 12TH DENCO CAPT D.T. FENNER, JR., DC, USN 

HEADQUARTERS, FMF PACIFIC CAPT R. W. JONES, MC, USN 

FORDO CAPT P.C. ALEXANDER, DC, USN 
AO C APT L. W , GAY, MSC. USN 

FIRST MARINE DIVISION CAPT R.C. HODGES. MSC, USN 

FIRST FORCE SERVICE SUPPORT GROUP FIRST DENCO CAPT J. D. MAHONEY, DC, USN 

FIRST MARINE AIRCRAFT WING CAPT J.W. BROUGH, MC, USN 

THIRD FORCE SERVICE SUPPORT GROUP 
(DETA) 11TH DENCO CAPTC.R. DIEM, DC, USN 

FIRST MARINE BRIGADE CDR M.O. ABBOTT. MC, USN 

21STDENC0 CAPTL.M. MULDROW, JR., DC, USN 
AOLTLOCHHART, MSC, USN 

THIRD MARINE DIVISION SURGEON CDR A.M. DRAKE, MC, USN 

THIRD FORCE SERVICE SUPPORT GROUP THIRD DENCO CAPT R.M. ROMANIELLO, DC, USN 

THIRD MARINE AIRCRAFT WING CAPT CH. SPENCE, MC, USN (ADDU) 

FIRST FORCE SERVICE SUPPORT GROUP 13TH DENCO CAPT R. E. WILLIAMS, JR. , DC, USN 

FLDMEDSERVSCOL. CAMP PENDLETON CO CAPT L. NICHOLS. MSC, USN 

XO LCDR E.J. LOOS, MSC, USN 

FLDMEDSERVSCOL, CAMP LEJEUNE CO CAPT E.J. STEWARD, MSC, USN 

XO CDR N.E. DENISON. MSC, USN 



—Roster prepared by BUMED MED2121 



CUT ALONG THIS LINE 



NAVAL MEDICAL RESEARCH & DEVELOPMENT 
COMMAND, BETHESDA, MD 



ARMED FORCES INSTITUTE OF PATHOLOGY, 
WASHINGTON, DC 



ARMED FORCES RADIOBIOLOGY RESEARCH 
INSTITUTE, BETHESDA, MD 



NAVAL MEDICAL DATA SERVICES CENTER, 
BETHESDA, MD 



NAVHOSP, PATUXENT RIVER. MD . 



NAVREGMEDCLIN1C, QUANTICO, VA . 



ITALY 

U.S. NAVREGMEDCEN. NAPLES . 



U.S. NAVREGDENCEN, NAPLES . 



U.S. NAVAL ENVIRONMENTAL & PREV MED 
UNIT 7, NAPLES 



JAPAN 

U.S. NAVREGMEDCEN, YOKOSUKA . 



U.S. NAVREGDENCEN. YOKOSUKA . 



U.S. NAVREGMEDCEN, OKINAWA . 



CO CAPT J.D. BLOOM. MC, USN 



DIRCAPTE.C. COW ART, JR., MC, USN 



DIR CAPT P. E. TYLER, MC, USN 
AO CAPT E.D. MATIEK, MSC. USN 



CO CAPT I.E. ANGELO, MSC, USN 
XO LTS.L. SMITH, MSC, USN 

CO CAPT J. GRAVES, MSC, USN 
DCS CAPT J.P. SENN, MC, USN 
DAS LT M.A. BLOME. MSC. USN 

CO CDR J.R. ERIE, MSC, USN 
DAS LCDR D.D. WILSON. MSC, USN 
CH NURSE CAPT E. O'NEILL, NC, USN 



CO CAPT N, W, COOLEY, MC, USN 

DCS J. A. HANSEN, MC, USN 

DAS CDR J. A. BOYLE, MSC, USN 

CH NURSE CAPT M. BIRKHIMER, NC, USN 

CO CAPT J. A. MCKINNON, DC, USN 
DCS CAPT A.E, AMATO, DC, USN 
DAS CDR P.T. RAY, MSC, USN 



OIC CDR J.W. POUNDSTONE, MC, USN 
AO LCDR D.E. ANDERSON. MSC, USN 



CO CAPT B.L. JOHNSON, MC, USN 
DCS CDR J.P. SMYTH, MC, USN 
DAS LCDR R. GUTSHALL, MSC, USN 
CH NURSE CAPT P. MORIS, NC, USN 

CO CAPT E.T. WITTE, DC, USN 
DCS CAPT R.E. HOWE, DC, USN 
DAS LCDR E.C. PIERSOL, MSC, USN 

CO CAPT D.Q. WILSON, MC, USN 
DCS CAPT K. A. GAINES, MC. USN 
DAS CDR C. DEKREY, MSC, USN 
CH NURSE CAPT E. SANFORD. NC, USN 



NAVREGDENCEN, CHARLESTON, SC . 



NAVHOSP. BEAUFORT, SC . 



NAVREGDENCEN, PARRJS ISLAND, SC . 



NAVREGMEDCEN, JACKSONVILLE, FL. 



NAVREGDENCEN, JACKSONVILLE, FL. 
NAVREGMEDCLINIC, KEY WEST, FL. . . 



NAVREGMEDCEN, MEMPHIS, 
MILLINGTON, TN 



NAVREGMEDCEN, ORLANDO, FL. 



NAVREGDENCEN, ORLANDO, FL, 



NAVAEROSPREGMEDCEN, PENSACOLA, FL. 



NAVREGDENCEN, PENSACOLA, FL. 



NAVAEROMEDRSCHLAB, PENSACOLA, FL. 
NAVAEROSPMED1NST, PENSACOLA, FL. . . . 



CO CAPT R.G. GRANGER, DC, USN 

DCS CAPT T.M. ALLENSWORTH. JR.. DC, USN 

DASLTD.C. DUNKLEMAN, MSC, USN 

CO CAPT W.R. MULLINS. MC, USN (ADDU) 
DAS LCDR W. LUDWIG, MSC, USN 
CH NURSE CAPT B. SLATER, NC. USN 

CO CAPT R.D. ULREY, DC, USN 
DCS CAPT J, C. KELLY, JR.. DC. USN 
DAS LCDR L.R. MAASSEN, MSC, USN 

CO CAPT W.M. MCDERMOTT, JR., MC, USN 
DCS CAPT D.F. HAGEN, MC, USN 
DAS CAPT L.J. SCHAFFNER, MSC, USN 
CH NURSE CAPT A. FOLEY. NC, USN 

CO CAPT E.E, MCDONALD. JR., DC, USN 

DCS CAPT E.H. PLUMP, DC, USN 

DAS CAPTR.L. WENTWORTH, MSC. USN 

CO LCDR P. DANIEL, MSC, USN 

CH NURSE CAPT D. DUNN, NC. USN 



CO CAPT C.W. BRAMLETT, MC, USN 
DCS CAPTR.H. MEADERS, MC, USN 
DAS CDR B.L. STEPHENS, MSC. USN 
CH NURSE CAPT M. MAYNARD, NC, USN 

CO CAPT J.A. ZTMBLE, MC, USN 

DCS CAPT W.A. SCHEFSTAD, MC, USN 

DAS CDR C.R. LOAR, MSC, USN 

CH NURSE CAPT J.M. REDGATE, NC, USN 

COH.C. FUND, JR., DC, USN 
DCS CAPT J.E. KLIMA, DC, USN 
DAS LCDR R. REYSEN, MSC, USN 

CO RADM R.F. MILNES, MC, USN 
DCS CAPT N.D. BROUSSARD, MC, USN 
DAS CDR A.D. HATTEN, MSC, USN 
CH NURSE CAPT K. WILSON, NC, USN 

CO CAPT T.W. MCKEAN, DC. USN 
DCS CAPT K.E. BROWN, DC, USN 
DAS LCDR P.R. COWART, MSC, USN 

CO CAPT R.E. M1TCHEL, MC, USN 

CO CAPT R.P. CAUDB.L, MC, USN 
XO CAPT D.J. BSIDEAU. MSC, USN 



MARIANA ISLANDS 

U.S. NAVREGMEDCEN, GUAM . 



CO CAPT M.C. CARVER, MC. USN 

DCS CAPT J.A. AUSTIN, MC. USNR 
DAS LCDR K.L. LASHLEY, MSC, USN 
CH NURSE CAPT F. FRAZIER, NC, USN 

CO CAPT R.D. PRINCE, DC, USN 

DCS CAPT H.C. DEATON, DC, USN 
DAS LCDR O.H. GR1SHAM, MSC, USN 

COMNAVMARIANAS CAPT R.D. PRINCE, DC. USN (ADDU) 



U.S. NAVREGDENCEN, GUAM . 



CAIRO, EGYPT 

U.S. NAVMEDRSCHUNIT3, 



PHILIPPINES 

U.S. NAVREGMEDCEN, SUBIC BAY, RP . 



CO CAPT R.H. WATTEN, MC, USN 
AO LCDR H. PETERSEN, MSC, USN 
SR NURSE CDR S. SOSS, NC, USN 



CO CAPT R.A. PROULX, MC, USN 
DCS LCDR J. S. MILLER, JR., MC, USNR 
DAS CDR R.M. COAN. MSC, USN 
CH NURSE CDR J. KELLY, NC, USN 



NAVAL DISEASE VECTOR ECOLOGY & 
CONTROL CENTER, JACKSONVILLE, FL. 



EIGHTH NAVAL DISTRICT 

NAVREGMEDCEN, CORPUS CHRISTI, TX. 



NAVHOSP, GUANTANAMO BAY, CUBA . 



NAVREGMEDCLINIC, NEW ORLEANS, LA. 
NAVREGMEDCEN, GREAT LAKES, IL 



OIC LCDR L.L. SHOLDT, MSC, USN 
AO LCDR B.R. FORO, MSC, USN 



DMO LCDR K. SNOW, MSC, USN 

DDO CAPT A.J. BARTOSH. DC, USN (ADDU) 

CO CAPT T.J. TRUMBLE, MC, USN 
DCS CAPT C.F. MAAS, MC, USN 
DAS CDR W.A. GODFREY. JR., MSC, USN 
CH NURSE CAPT K. JONES, NC, USN 

CO CAPT L.R. FOUT, MC, USN 
DAS LCDR C.J. PARKER, MSC, USN 
CH NURSE CDR F. DAVISON, NC. USN 

CO LCDR K. SNOW. MSC, USN 

CH NURSE CDR C. KOZARE, NC, USN 

CO CAPT R.J. SEELEY, MC, USN 
DCS CAPT H.E. SHUTE, MC, USN 
DAS CDR R.A. PAYTON, MSC, USN 
CH NURSE CAPT J. BARNES, NC, USN 



NAVRECDENCEN, GREAT LAKES. II, 



COCAPTR.G. SHAFFER, DC, USN 

DCS CAPT H.B, MCWHORTER, DC, USN 
DAS CDR P.J. COLLIER, MSC, USN 

NAVDENTALRSCHINSTITUTE, 
GREATLAKES, a CO CAPT M.R. WIRTHLIN. JR.. DC, USN 

NAVHOSPCORPSCOL. GREAT LAKES, 1L CO CDR N. OGLESBY, MSC. USN 

XO LCDR C.H. HAYES, MSC. USN 
SR NURSE CDR P. FLEURY. NC. USN 

NAVHOSP. ROOSEVELT ROADS, PR CO CAPT P.C. GREGG. MC. USN 

DAS CDR T.F. LEVANDOWSK1. JR.. MSC. USN 
CH NURSE CAPT D. JACOBSEN. NC, USN 

NAVREGDENCEN, ROOSEVELT ROADS, PR CO CAPT D.E. BARLOW, DC. USN 

DCS CAPT R.A. MURPHY, DC, USN 

DASLT W.M. MILLS, MSC, USN 



ELEVENTH NAVAI DISTRICT 

NAVREGMEDCEN, CAMP PENDLETON, CA. 



NAVREGDENCEN. CAMP PENDLETON, CA. 



NAVREGMEDCEN. LONG BEACH. CA. 



NAVREGDENCEN. LONG BEACH, CA. 



NAVAL SCHOOL OF HEALTH SCIENCES, 
SAN DIEGO, CA 



DMO RADM J.W. COX. MC. USN (ADDU) 
DIRDENACTYS RADM J.J. THOMAS. DC. USN (ADDU) 

CO CAPT C.S. LAMBDiN. MC, USN 
DCS CAPT C.L. GAUDRY, MC, USN 
DAS CDR T.E.THOMAS, MSC, USN 
CH NURSE CAPT L. EMOND, NC, USN 

CO CAPT W.E.SUGG. JR., DC, USN 

DCS CAPT P.J. RE1SMAN, DC, USN 
DAS LCDR L.E. BELTER, MSC, USN 

CO CAPTQ.E, CREWS, MC, USN 
DCS CAPT E.E. FREEMAN. MC, USN 
DAS LCDR D.N. BENANDER, MSC. USN 
CH NURSE CAPT M. DONOGHUE, NC, USN 

CO CAPT S.E. PEPEK, DC. USN 

DCS CAPT F. A. PAPERA, DC, USN 

DAS LCDRG.R. HARRINGTON, MSC, USN 



CO CAPT W.E. MCC0NV1LLE. MSC, USN 
SR NURSE CAPT M. PERLOW. NC. USN 



NAVAL ENVIRONMENTAL & PREV MED 
UNITS, SAN DIEGO. CA 



NAVREGMEDCL1N1C. PORTHUENEME, CA. 
NAVREGMEDCEN, SAN DIEGO, CA 



OIC CAPT T.R. BYRD. MC. USN 
AO LCDR E.R. WOOLL, MSC, USN 

CO CDR F. TEAGUE, MSC. USN 

CH NURSE CDR E. PETERS. NC, USN 

CO RADM J.W. COX, MC, USN 

DCS CAPT J. S, CASSELLS. MC, USN 
DAS CAPT E.N. BUCKLEY, MSC, USN 
CH NURSE CAPT E. PFEFFER. NC, USN 

NAVREGDENCEN. SAN DIEGO, CA CO RADM J.J. THOMAS, DC. USN 

DCS CAPT E.J. HEINKEL, JR., DC, USN 
DAS LCDR J. GALBREATH, MSC, USN 

NAVHLTHRSCHCEN. SAN DIEGO, CA CO CAPT R.H. RAHE, MC, USN 

XOCAPTJ.E. LANG, MC, USN 

NAVREGMEDCEN, OAKLAND. CA CO RADM W.M. LONERGAN. MC, USN 

DCS CAPT L.U. PULICICCHIO, MC, USN 
DAS CDR F.D.R. FISHER, MSC. USN 
CH NURSE CAPT P. BUTLER, NC, USN 



NAVHOSP, LEMOORE. CA. 



NAVREGDENCEN, SAN FRANCISCO. CA. 



CO CAPT F. P1TTINGT0N. MSC, USN 

DCS CAPT O.B. EMERINE, MC. USN 

DAS LCDR R.R. WELCH, MSC. USN 

CH NURSE CAPT N. MACDOWELL. NC, USN 

COCAPTJ.E. HYDE, DC. USN 

DCS CAPT J.W.R. ANDERSON, DC. USN 

DAS CDR L.W. JOHNSON. MSC. USN 



NAVDISVECTECOI.CONCEN, ALAMEDA. CA OIC LCDR L.A. LEWIS, MSC. USN 

AO LCDR D.R. GRAY. MSC, USN 

NAVBIOSCILAB. OAKLAND, CA CO CAPT J.F. PRIBNOW, MSC. USN 

AOLTJ.D. FORD. MSC. USNR 

THD3TEENTH NAVA1 DISTRICT DMO CAPT R.C. ELLIOTT. MC, USN (ADDU) 

DDO CAPT R.G. THOMPSON, DC, USN (ADDU) 

NAVREGMEDCEN. BREMERTON, WA CO CAPT R.C. ELLIOTT, MC. USN 

DCS CAPT P.D. COOPER, JR.. MC, USN 

DAS CDR D.D. PALMER. MSC. USN 

CH NURSE CAPT L. PETERSON. NC. USN 



NAVREGDENCEN, BREMERTON, WA. 



CO CAPT R.G. THOMPSON. DC. USN 

DCS CAPT J.F. SCOTT, DC, USN 
DAS LT W. JOSEPH, MSC, USN 

NAVHOSP. WH1DBEY ISLAND, OAK 

HARBOR, WA CO CAPTG.W. BALDAUF. MSC. USN 

CH NURSE CDR K. KENDALL. NC, USN 

NAVREGMEDCL1NIC, SEATTLE, WA CO CAPT R.L. SURFACE, MSC, USN 

SR NURSE LT T. WHITE, NC, USN 

FOURTEENTH NAVAL DISTRICT DMO CAPT A.L. SOLGAARD. MC. USN (ADDU) 

DDO CAPT N.D. WILKIE, DC, USN (ADDU) 

NAVREGMEDCLINIC, PEARL HARBOR. HI CO CAPT A.L, SOLGAARD, MC, USN 

DAS CDR D.R. FERGUSON, MSC, USN 
SR NURSE CAPT A. GOMES, NC, USN 

NAVREGDENCEN, PEARL HARBOR, HI CO CAPT N.D. WILKIE. DC. USN 

DCS CAPT A.D. LOIZEAUX, DC, USN 
DAS LCDR J. D. DELAUGHTER, MSC, USN 

NAVMEDADM1NUN1T. TRIPLER ARMY 
MEDICAL CENTER. PEARL HARBOR. HI OIC CDR C.J . MOORE. MSC. USN 

NAVAL ENVIRONMENTAL & PREV MED 

UNIT 6, PEARL HARBOR. HI OIC CAPT W.B. MAHAFFEY . MC, USN 

AO LT J.M. CONSENZA. MSC, USN 

NAVAL DISTRICT, WASHINGTON, DC DMO RADM J.T. HORGAN. MC, USN (ADDU) 

DDO CAPT H.C. PEBLEY. DC. USN (ADDU) 

NAVREGMEDCLINIC, ANNAPOLIS, MD CO CDR P. JOHNSON, MSC, USN 

CH NURSE CAPT L. N1CKERS0N, NC, USN 

NATIONAL NAVAL MEDICAL CENTER. 

BETHESDA, MD CO RADM J.T. HORGAN, MC, USN 

DCS CAPT M. NIEVES, JR., MC, USN 

DAS CDR R. ZENTMYER, MSC, USN 

CH NURSE CAPT H, FURMANCHIK. NC. USN 



NATIONAL NAVAL DENTER CENTER, 
BETHESDA. MD 



NAVAL HEALTH SCIENCES EDUCATION & 
TRAINING COMMAND, NNMC, 
BETHESDA. MD 



NAVAL SCHOOL OF HEALTH SCIENCES, 
BETHESDA, MD 



NAVAL MEDICAL RESEARCH INSTITUTE, 
BETHESDA, MD 



CAPT H.C. PEBLEY. DC. USN 
DCS CAPTR.D. CULLOM, DC, USN 
DAS CAPT M.K. LAW. MSC, USN 



CO RADM A.C. WILSON, MC. USN 
XO CAPT DM. ALLMAN. DC. USN 
AO 



CO CAPT W.J. AUTON . JR. . MSC. USN 
XO CDR T. FISHER. MSC, USN 



CO CAPT W.F. MINER. MC. USN 
AO CDR R.A. MORIN. MSC. USN 



NOTES & ANNOUNCEMENTS 



IN MEMORIAM 

John C. Lang, Ph.D., a management consultant and 
lecturer in the Executive Medicine Program and other 
Medical Department management courses at the Naval 
School of Health Sciences, Bethesda, Md., died 18 Sept 
1979 at the age of 68. 

Born in Delmont, S.D., Dr. Lang earned a bachelor's 
degree in chemistry and physics from Valley City State 
College in North Dakota and a master's degree in per- 
sonnel administration from Northwestern University. 
He later graduated with a master's degree and a doc- 
torate in administration and supervision from George 
Washington University. 

Dr. Lang served with the U.S. Navy in World War II 
then joined the Bureau of Naval Personnel. As an 
authority on curriculum and personnel, he helped the 
governments of Greece and Turkey set up their naval 
training programs and served as a naval advisor to 
other countries, including Iran, Denmark, Spain, 
Portugal, and South Vietnam. 

Since 1972, Dr. Lang had been a regular lecturer in 
Medical Department programs, participating in Pro- 
spective Commanding Officers' Conferences, Execu- 
tive Medicine Programs, and the Health Care Adminis- 
tration Program. His presentations were characterized 
by the nicest blend of insights and humor, and were 
consistent highlights of the programs. He also had the 
unique ability to help the students analyze their leader- ] 
ship style and understand its effect in motivating 
others. 

CAPT Wood G. van Valkenburgh, MC, USN, a Navy 
staff physician at the National Naval Medical Center, 
Bethesda, Md., died 21 Aug 1979 at age 46, 

Dr. van Valkenburgh was born in East Orange, N.J., 
and graduated from the Virginia Polytechnic Institute 
and the Medical College of Virginia. He entered the 
Navy and served his internship at the National Naval 
Medical Center. He served at sea from 1960 to 1962 and 
then took further training in Philadelphia, Pa., and 
Richmond, Va. Dr. van Valkenburgh was a staff physi- 
cian at NRMC Portsmouth, Va., before returning to the 
National Naval Medical Center in 1970 as head of the 
rheumatology branch of the Internal Medicine Service. 
He also was an associate professor of medicine at the 
Uniformed Services University of the Health Sciences 
Medical School, Bethesda, Md. 

Dr. van Valkenburgh was a diplomate of the Ameri- 
can College of Physicians. 



POSTDOCTORAL ASSOCIATESHIPS 

Applications are now being accepted for the post- 
doctoral research associateship programs conducted by 
the National Research Council of the National Academy 
of Sciences on behalf of the Naval Medical Research 
and Development Command (NMRDC). 

Under the programs, postdoctoral biomedical engi- 
neers and medical, biological, and behavioral scientists 
participate in biomedical research projects conducted in 
NMRDC laboratories. Awards, made on a competitive 
basis, are tenable at five Navy facilities: the Naval 
Medical Research Institute, Bethesda, Md.; the Naval 
Aerospace Medical Research Laboratory, Pensacola, 
Fla.; the Aircraft and Crew Systems Technology Direc- 
torate, Naval Air Development Command, Warminster, 
Pa.; the Naval Submarine Medical Research Labora- 
tory, Groton, Conn.; and the Naval Health Research 
Center, San Diego, Calif. 

Areas in which the research associateships are 
awarded are: experimental medicine, immunology, 
undersea medicine, aerospace medicine, behavioral 
sciences, biochemistry, biophysics, environmental 
stress, microbiology, parasitology, virology biomag- 
netics, physiology, and radiation biology. 

Candidates must hold an M.D., a D.D.S., or a Ph.D. 
degree or the equivalent, and must be research 
oriented. 

The National Research Council screens the candi- 
dates' records, selects applicants, and approves the 
scientific merits of laboratory projects and the creden- 
tials of research advisors. 

Applications must be postmarked no later than 15 
Jan 1980 and must be received in the Council's Asso- 
ciateship Office no later than 25 Jan 1980. Supporting 
documents must be received by 11 Feb 1980. 

For further details, write: Associateship Office (JH- 
608-NI), National Research Council, 2101 Constitution 
Ave., N.W., Washington, D.C. 20418. 

OCCUPATIONAL HEALTH WORKSHOP 

The 22nd Navy Occupational Health Workshop will 
be held 14-18 Jan 1980 at the U.S. Grant Hotel, San 
Diego, Calif. 

The workshop is open to all occupational health pro- 
fessionals. There is no registration fee. 

For further information, contact: Dianne Best or LT 
J. Moody, MSC, USN, Navy Environmental Health 
Center, Naval Station, Norfolk, Va. 23511. Telephone: 
Autovon 690-4657, Commercial (804) 444-4657, 



Volume 70, November 1979 



27 



PSYCHIATRY CLERKSHIPS 

Psychiatry clerkships for third and fourth year medi- 
cal students from the Uniformed Services University of 
the Health Sciences has been established at Parris 
Island, S.C., in conjunction with the Department of 
Psychiatry, Naval Hospital, Beaufort, S.C. 

The clerkship is entitled, "Recruit Training: Psychi- 
atric Aspects." Its general objective is to familiarize the 
medical student with the unique aspects of intensive 
Marine recruit training and to help the student develop 
familiarity and skill in assessing psychiatric maladapfa- 
tion to the training experience and its management. It 
will provide the clerk with opportunities to study indi- 
cations and decision making in the administrative dis- 
charge process. 

The clerks will gain expertise in the evaluation of 
recruits referred from platoons for psychiatric assess- 
ment and help to view the recruit as undergoing a 
stressful, structured transition from late adolescence 
into early adulthood. The necessity of being aware of 
pre- enlistment personality formation as well as the 
physical, social, and psychological structure of the 
training depot and its personnel will be experienced. 
There will also be an experience in the evaluation and 
inservice training of drill instructors. 

The clerkships will be four weeks in duration, limited 
to two students at a time, and offered any time during 
the academic year. 



ADVANCE APPROVAL FOR RTC CARE 

A new method by which service families can obtain 
advance information on whether CHAMPUS will share 
the cost of care for an emotionally disturbed child in a 
residential treatment center (RTC) has been announced 
by CHAMPUS officials. 

Under the CHAMPUS Regulation, approval by 
OCHAMPUS is required before any care in an RTC can 
be cost-shared by CHAMPUS. There is no require- 
ment, however, that such approval be obtained before 
treatment starts. 

There is always the possibility that care obtained be- 
fore approval by OCHAMPUS will be denied cost- 
sharing upon review. In this instance, the service 
family would have to pay the entire bill. 

To avoid this, the new procedure permits the service 
family to obtain a review before the child's admission 
and to obtain an advance decision on whether 
CHAMPUS will cost-share the first 30 days. Under the 
previous procedure, no such review and decision were 
possible until the child had actually entered the RTC. 

Any authorization for initial admission — whether it is 
granted before or after admission — will, generally, be 



for a maximum of 30 days. The only condition under 
which the authorization period would be longer than 30 
days is where the RTC has submitted a treatment plan 
which can be considered along with the request for 
initial authorization. If the initial evaluation indicates 
the patient needs extended RTC care, a request should 
be sent to OCHAMPUS as soon as possible by the RTC, 
but not later than 30 days after the initial admission. 

Service families are encouraged to use the new pro- 
cedure to protect themselves from incurring large bills 
for treatment which will not be cost-shared by 
CHAMPUS. Details of CHAMPUS benefits for RTC 
care and how to apply for them, including the informa- 
tion required to evaluate a request for either an initial 
admission or extended care, can be obtained from a 
CHAMPUS advisor or by writing to OCHAMPUS, 
Aurora, Colo. 80045. 



INPATIENT MEDICAL CARE 
CHARGES INCREASED 

The Defense Department announced that effective 1 
Oct 1979, dependents of active duty, retired, and 
deceased servicemembers will be charged $5 per day 
for inpatient care at Uniformed Services hospitals. The 
previous charge was $4.65 per day. 

New cost-share requirements went into effect on the 
same day for inpatient care received from civilian 
sources by spouses and children of active duty service- 
members under CHAMPUS, These individuals will pay 
$5 per day, with a minimum cost-share requirement of 
$25 if they are hospitalized for less than five days. 
Previously, they paid $4.65 per day, with a minimum 
requirement of $25. 

By law, the inpatient cost-share requirement under 
CHAMPUS for spouses and children of active duty ser- 
vicemembers is based on the charge at Uniformed Ser- 
vices hospitals. 

The new rate does not apply to CHAMPUS cost- 
sharing of inpatient care for retirees or dependents of 
retired or deceased members. Individuals in these 
categories who are eligible for CHAMPUS pay 25 
percent of the allowable medical facility charges and 
professional fees. 

Inpatient charges at Uniformed Services hospitals 
are adjusted periodically to reflect changes in Uni- 
formed Services pay. Previously, this adjustment was 
made at the start of a calendar year. Beginning last 
year, however, the adjustment was made at the start of 
the fiscal year. 

The increase from $4.65 per day to $5 per day is ap- 
proximately the same percentage increase as the pay 
raise that went into effect on 1 Oct 1979. 



28 



U.S. Navy Medicine 



BUMED SITREP 



TALC POUDRAGE 

The association of malignant mesothelioma of the 
pleura with inhalation of asbestos dust particles is well 
recognized. During the 1930s insufflation of talc into 
the pleural space was used to create a chemical 
pleuritis in patients with recurrent pneumothorax. This 
practice reached its zenith during the 1940s and, per- 
haps, the early 1950s, and was replaced by other meth- 
odologies during the 1960s. Some forms of talcum pow- 
der may be contaminated with up to 85 percent asbestos 
fiber. Because of this, BUMED has initiated negotia- 
tions with the Veterans Follow-Up Agency, of the 
National Academy of Sciences, to follow a cohort of 
persons who had talc poudrage 15 to 35 years ago. The 
progress in identifying this cohort has been extremely 
slow and difficult. Individual thoracic surgeons, chest 
physicians, internists, and other primary care physi- 
cians, who have knowledge of groups of patients who 
can be identified as having been treated by talc poud- 
rage, are asked to communicate the information in 
writing to CAPT R.L. Marlor, MC, USN, BUMED 
(MED 314). CAPT Marlor is also interested in obtain- 
ing samples of talcum powder such as that used for talc 
poudrage in earlier years for analysis of asbestos fiber 
content. Some of this material may still be found in the 
"bottom drawers" of surgical suites in some of our 
older hospitals. Samples, if noted, should be labeled 
and forwarded to MED 314, at the Bureau of Medicine 
and Surgery. 

ENERGY COMSUMPTION BELOW 1975 BASELINE 

For the third quarter of FY 79, BUMED energy 
consumption was 4.5 percent below the 1975 baseline. 
However, this is an increase of almost 2 percent over 
the same period during FY78. NAVHOSP PAXRW and 
NRMCs at Charleston, Jacksonville, Newport, Long 
Beach, Philadelphia, and Yofcosuka were significantly 
below their FY 75 baselines. 



PREVENTIVE MEDICINE ACTIVITIES ES 
ASSOCIATION WITH HURRICANE DAVID 

In response to requests from DOD, the Joint Chiefs 
of Staff, and the Department of State, CINCLANT/ 
CINCLANTFLT was requested to lend assistance to 
Dominica and the Dominican Republic following the 
massive destruction wrought by Hurricane David. 
Preventive medicine personnel were required as 
members of Disaster Assistance Teams. In order to 



meet this requirement and maintain fleet support, it 
was necessary to call upon additional preventive medi- 
cine personnel outside of the NAVENPVNTMEDUs. 
Personnel were dispatched from NAVENPVNTMEDU- 
2, Norfolk, Va., NAVENPVNTMEDU-5, San Diego, 
Calif., NAVREGMEDCEN Portsmouth, Va., NAV- 
AEROSPREGMEDCEN Pensacola, Fla., NAVREG- 
MEDCEN Camp Lejeune, N.C., and the NAVENVIR- 
HLTHCEN Norfolk, Va. A Disease Vector Control Team 
from the Navy Disease Vector Ecology and Control 
Center, Jacksonville, Fla., deployed to the Dominican 
Republic and one from Navy Disease Vector Ecology 
and Control Center, Alameda, Calif., were dispatched 
to assist a Pan American Health Organization Team on 
the Island of Dominica. 

EXECUTIVE MEDICINE CLASS NOMINATIONS 
AVAILABLE 

The first FY 80 Executive Medicine Class began 
15 Oct 1979. Some quotas are still available for classes 
convening 26 Nov 1979, 7 Jan 1980, and 28 Jan 1980. 
Medical Corps nominations should be submitted to 
Chief, Bureau of Medicine and Surgery (MED 21). 

AGENT ORANGE UPDATE 

Agent Orange was an herbicide aerially dispersed in 
Vietnam, containing a specific combination of 2, 4-D 
and 2, 4, 5-T as a potent toxin. A number of side ef- 
fects, including carcinogenesis, teratogenesis, and the 
like, have been alleged to be associated with exposure 
to Agent Orange toxicants. A primary sign of acute 
exposure to Agent Orange was chloracne. This derma- 
tologic condition was so common a sequelae to 
exposure, that its absence by history in a patient 
alleging Agent Orange exposure makes it unlikely that 
exposure occurred. Most Agent Orange exposures in 
active duty personnel occurred in the Air Force where 
the material was handled, transferred, and sprayed 
over broad areas. Ground exposure was less likely, 
since it took approximately 6 weeks for defoliation to 
take place. BUMED (MED 31412) is attempting to 
identify any coincidental exposure among Navy and 
Marine Corps personnel, and would be interested in 
verified or anecdotal information on Marine Corps 
personnel, Seabees, or crews of riverine patrol boats, 
who may have actually handled or sprayed Agent 
Orange material. Write or call CDR R.V. Peterson, 
MSC, USN, BUMED (Med 31412), Autovon 294-4384, 
Commercial (202) 254-4384. 



Volume 70, November 1979 



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